For women taking anticonvulsant drugs, a targeted so nographic examination at midpregnancy is recommended by some to search for anomalies. Testing to assess fetal well-being is generally not indicated for women with uncomplicated epilepsy.
For women desiring to breastfeed, data regarding the safety of the various anticonvulsant medications are limited. That said, no obvious deleterious efects, such as long-term cognitive issues, have been reported (Briggs, 2015; Harden, 2009c). Of birth control methods, oral contraceptive pill failure rates are higher with some of the anticonvulsant agents, especially lamotrigine. Thus, other more reliable methods should be considered (Chap. 38, p. 680).
TABLE 60-2. Teratogenic Effects of Common Anticonvulsant Medications
Neural-tube defects, clefts, cardiac anomalies; associated developmental delay
Fetal hydantoin syndrome-craniofacial anomalies, fingernail hypoplasia, growth deficiency, developmental delay, cardiac anomalies, clefts
Fetal hydantoin syndrome, as above; spina bifida
Clefts, cardiac anomalies, urinary tract malformations aRisk categories from Briggs, 2015; Food and Drug Administration, 2011; Harden, 2009b; Holmes, 2008; Hunt, 2008.
Abnormalities of the cerebrovascular circulation include strokes-both ischemic and hemorrhagic, as well as anatomical anomalies, such as arteriovenous malformations and aneurysms. Cerebral ischemia is caused by reduction in blood low that lasts longer than several seconds. Early, neurological symptoms may manifest. Ater a few minutes, however, infarction often follows. Hemorrhagic stroke is caused by bleeding directly into or around the brain. It produces symptoms by its mass efect, by toxic efects of blood, or by increasing intracranial pressure. Of strokes in pregnant women, roughly half are ischemic and the other half hemorrhagic (Zofkie, 2018).
he current obesity endemic in this country, along with concomitant increases in rates of heart disease, hypertension, and diabetes, has increased the prevalence of strokes (Centers for Disease Control and Prevention, 2012). Women have higher lifetime risk of stroke than men and greater associated mortality rates (Martinez-Sanchez, 2011; Roger, 2012). Moreover, pregnancy increases the immediate and lifetime risk of both ischemic and hemorrhagic stroke (Jamieson, 2010; lung, 2010).
Stroke is relatively uncommon in pregnant women, occurring in 10 to 40 per 100,000 births, but it contributes disparately to maternal mortality rates (Lefert, 2016; Miller, 20 16; Yoshida, 2017). he incidence is rising as measured by pregnancy-related hospitalizations for stroke (Callaghan, 2008; Kukiina, 2011). Importantly, most are associated with hypertensive disorders or heart disease. Of the pregnancy-related mortality rate in the United States, 6.6 percent is due to cerebrovascular accidents, and 7.4 percent is associated with preeclampsia (Creanga, 2017). Of maternal deaths after 42 days postpartum, 9.8 percent were attributable to cerebrovascular accidents.