Mental health

Management of epilepsy in women of child bearing age

Question 11:
11a). In women with epilepsy, should antiepileptic therapy be prescribed as monotherapy or polytherapy to decrease the risk of fetal malformations?
11b). Does the use of folic acid preconceptually decrease the risk of foetal malformations in women with epilepsy?
11c). Do phenytoin, phenobarbital, valproic acid or carbamazepine enter breast milk in quantities which are clinically significant to the baby?

Management of epilepsy

  • Population:
    • women with epilepsy who may become pregnant
    • women with epilepsy on antiepileptic drug treatment wishing to breast feed
  • Interventions:
    • use of antiepileptic drugs as monotherapy or polytherapy during pregnancy
    • use of phenobarbital, phenytoin, valproate or carbamazepine during pregnancy
    • use of folic acid preconceptually and during early pregnancy
    • breast feeding while taking phenobarbital, phenytoin, valproate or carbamazepine
  • Comparison:
    • pregnant women with epilepsy taking no antiepileptic drugs
    • pregnant women without epilepsy
  • Outcomes:
    • congenital malformations in the infant
    • clinically important amounts of antiepileptic drugs secreted in breast milk.


Women with epilepsy should have seizures controlled as well as possible with the minimum dose of antiepileptic drug taken in monotherapy, wherever possible. Antiepileptic drug polytherapy should be avoided. Valproic acid should be avoided if possible.
Strength of recommendation: STRONG

Folic acid should routinely be taken by women with epilepsy of child bearing age who are on antiepileptic drugs.
Strength of recommendation: STRONG

Standard breast feeding recommendations remain appropriate for women with epilepsy on the antiepileptic drugs included in this review (phenobarbital, phenytoin, carbamazepine and valproic acid).
Strength of recommendation: STRONG

Evidence profile