Women with epilepsy who are pregnant or planning to be pregnant need additional guidance and care due to the complications that both seizures and anti-seizure medications (ASMs) can bring. The teratogenic potential of several commonly used ASMs limits their suitability in pregnancy and breastfeeding, meaning treatment plans often need adjusting. Changes in drug metabolism during pregnancy and postpartum are an additional important consideration. Drug doses must be carefully managed to balance the goal of seizure freedom with the teratogenic risks, taking up-titration requirements into account. The true impact of ASMs on the child’s long-term development is also a point of contention. A lack of high quality of data remains regarding some of the newer agents and common combination therapies.

Ongoing real-world data studies continue to assess factors influencing outcomes for pregnant women with epilepsy and their children. In this episode, epilepsy specialists talk on the care of women with epilepsy before, during, and after pregnancy, highlighting what they do in their own practice, and commenting on new data regarding folic acid supplementation, breastfeeding safety, and neurodevelopmental outcomes in children with prenatal ASM exposure. Hear exclusively from Marte-Helene Bjork, MD, PhD, Haukeland University Hospital, Bergen, Norway; Bruna Nucera, MD, Hospital of Merano, Merano-Meran, Italy; and Kimford Meador, MD, FAAN, Stanford University, Stanford, CA.