In view of the above statistics women with epilepsy who become pregnant or who are trying to become pregnant should take timely actions. Most women with epilepsy can and do have normal pregnancies.

Maternal seizures can be more hazardous to the child than the side effects of antiepileptics . A mother falling on her abdomen could also injure the fetus. In addition, a generalized tonic clonic seizure may actually induce premature labor and a miscarriage.

Women with epilepsy should follow the traditional rules for having a healthy pregnancy. People who have the most successful pregnancies are the people who are healthiest when they're not pregnant.

It's also a good idea for them to talk to their neurologist before they get pregnant so that they understand what the risks are, so they know what they're getting themselves in for.

Suffering women should work as part of a team with both their obstetrician and their neurologist. You can't really expect the obstetrician to know how to use anticonvulsant drugs any more than you can expect the neurologist to deliver the baby.

Delivery should take place in a clinic with facilities for providing specialized care to epileptic patients and with an associated neonatal intensive care unit. Antiepileptic drug administration should be continued during labor. It may be necessary to give parenteral medication or additional oral doses because of decreased absorption during a prolonged labor. Since the enzyme-inducing antiepileptic drugs are competitive inhibitors of prothrombin precursors, exposed infants are at increased risk for hemorrhage into body cavities and brain. The risk is greatest on the first day of life, and infants may need prolonged coagulation studies even if findings in the mother are normal. Administration of vitamin K is required to reduce the risk of hemorrhage. Current guidelines recommend the oral administration of 2 mg of vitamin K at birth, at the end of the first week, and in the fourth week of life.

Monitoring of maternal antiepileptic drug levels should continue postpartum. Levels gradually return to baseline by 12 weeks after delivery. Mothers should be advised to avoid sleep deprivation.

Many women with epilepsy can breast-feed. Both phenytoin and valproic acid are highly have only low levels of drug are present in breast milk. Additionally, phenytoin is very poorly absorbed from an infant's gastrointestinal tract. Therefore, breast-feeding is permissible with phenytoin or valproic acid. Carbamazepine and phenobarbital are present at higher levels in breast milk, and breast-feeding is less advisable with these agents. However, strong maternal preferences need to be considered. When the mother is taking phenobarbital, infants must be monitored for poor suck or lethargy. If either occurs, breast-feeding should be stopped. Information is currently lacking on the effects of newer antiepileptics on lactation.

In general, women with epilepsy have benefited in recent decades from greater understanding of the disorder; better diagnostic tools; greater awareness of special issues such as birth control, pregnancy, sexual function, and menopause; and attempts to formulate individualized, safe approaches to these issues for each woman. More women also are being included in the testing of new medications and other treatments, because what works for a man may not work the same way for a woman. Pregnancy can be made safer both for women and the newborn child by careful planning and monitoring in association with trained professionals.