Pregnancy in women who have epilepsy Page B. Pennell, MD Emory Epilepsy Program, Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Suite 6000 Atlanta, GA 30322, USA More than one million women who have epilepsy in the United States are in their active reproductive years and give birth to more than 24,000 infants each year. It is estimated, however, that the total number of children in the United States exposed in utero to antiepileptic drugs (AEDs) is nearly two times that amount with the emergence of AED use for other illnesses, including headache, chronic pain, and mood disorders [1], and AEDs are one of the most frequent teratogen exposures for all pregnancies [2,3]. Many of the principles about AED use during pregnancy outlined in this article can be extrapolated to women who have any disorder treated with these agents. Although the majority of women who have epilepsy have a normal pregnancy with favorable outcomes, they do have increased maternal and fetal risks compared with the general population. Careful planning and management of any pregnancy in a woman who has epilepsy is essential to minimize these risks. The reduction of these risks begins with preconcep- tional planning. The initial visit between the physician and a woman of childbearing age who has epilepsy should include a discussion about family planning. Topics should include effective birth control, the importance of planned pregnancies with AED optimization and folate supplementation before conception, obstetric complications, and teratogenicity of AEDs versus the risks for seizures during pregnancy. The goal is effective control of maternal seizures with the least risk to the fetus. Funding supported by a Specialized Center of Research grant P50 MH68036 from the National Institutes of Health. Dr. Pennell has received speaking honoraria from GlaxoSmithKline (Durham, NC); UCB Pharma (Smyrna, GA); Novartis (Morristown, NJ); and Pfizer (Cambridge, MA); Dr. Pennell has received consulting fees from Ortho-McNeill (Raritan, NJ); Novartis, GlaxoSmithKline, and Elan Pharmaceuticals (San Diego, CA). Dr. Pennell has received re- search support from GlaxoSmithKline and Pfizer. E-mail address: page_pennell@emoryhealthcare.org 0733-8619/04/$ - see front matter Ó 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.ncl.2004.07.004 Neurol Clin 22 (2004) 799–820