86,87 Among the new AEDs it. has been further observed that a significant, fall in LEV scrum concentration may occur,85 the clinical relevance of which is still unclear. At least with LTG and OXC treatment therapeutic drug monitoring may be helpful.85 More systematic studies of the effects of pregnancy on the pharmacokinetics of new AEDs are urgently required.85 Complications such as hyperemesis, vaginal bleeding, pre-eclampsia,

or peripartal problems such as early contractions, weak contractions, or an increased Inhibitors,research,lifescience,medical caesarean section rate occur twice as often as in healthy women.88,89,90 Finally, one should not ignore the fact, that during pregnancy other possibilities exist that may trigger epileptic seizures, even in non epileptic women. If unexpected seizure relapses occur in patients with epilepsy, one should therefore always consider and exclude Inhibitors,research,lifescience,medical potential additional causative factors such as cerebrovascular insults, cerebral processes, cerebral infections, toxic or metabolic causes, or eclampsia.91 Risk factors for the child: possible complications during pregnancy, delivery, and the postnatal period Possible complications during

pregnancy Most probably generalized tonic-clonk seizures during pregnancy may threaten the child directly (trauma) and indirectly (reduced placental perfusion.)55 Selleckchem trans-isomer however, there are no convincing data on these possible risks. Inhibitors,research,lifescience,medical We know that spontaneous abortions that correspond Inhibitors,research,lifescience,medical with seizures very rare.71,92 However, the rate of

stillbirths is higher (5.1% vs 2.4%) in women who have suffered from seizures during pregnancy than in seizure -free patients.93 Complex partial seizures also temporarily influence the heart rate of the child due to contractions of the uterus and a resulting reduced fetal Inhibitors,research,lifescience,medical blood flow.94 Preeclampsia, placental bleeding, and immature deliver}’ occur 1.5 to threefold more often in epileptic patients than in the general population. Perinatal mortality is elevated by a factor of 1.2 to 2.95 Abnormally low birth weights are found 2.8-fold more frequently. Children of women with epilepsy also have an elevated risk of low APGAR scores and perinatal asphyxia.90 Over one decade perinatal mortality dropped continuously from 4.7% between 1977 and 1981 to 2.1% between 1987 and 199155 The perinatal mortality rate in the German EURAP register is 1 .4% ,96 One important aspect of the perinatal period is the risk of intracerebral bleeding in the infant. much Therefore, it. has been suggested for some decades that during the last 4 weeks of pregnancy the mother should be supplemented by vitamin K in order to overcome coagulopathies of the child due to the vitamin K deficiency that has been mostly attributed to the impact of enzyme-inducing AEDs.20,24,55 In addition, every child is supplied with vitamin K to minimize the bleeding risk. Recent data from a large cohort, study in Finland,97 however, do not.