Q: I am on anti-epileptic drugs. I take one tablet of Divalporex sodium 500 mg and three tablets of Phenytoin sodium 30 mg. I have been on this regime for more than 3 years, with slight adjustment by the doctor. I have read that women who take anti-epileptic drugs might have adverse effects in the fetus. I recently got married and am concerned about the malformation in the fetus during pregnancy. My doctor has started 2 tablets of folic acid 5 mg since my marriage. However, I am still worried on how the pregnancy will be and the side effects of these drugs on the fetus. I am not sure how long shall I be on these drugs, as I have not informed anybody regarding the medications. Should these drugs be stopped or continued during pregnancy?

A:You have not stated if you have had any seizures in the past three years; if not you are in a much better situation to have a baby and after the birth of the baby gradually stop medication. Unfortunately, there are lots of misconceptions among lay people about epilepsy. A person with well-controlled epilepsy is as normal as a person without epilepsy. Keeping people in the family in dark can be quite risky should an attack take place. At least your husband should know. A great majority of women with well controlled epilepsy (with medication) have normal pregnancy and normal babies. The frequency of seizures remains same in 50%, increases in 30% and reduces in 20% pregnant women. Abnormality in children born to mothers on anti epileptic drugs is 5 to 6%. This figure is not that alarming since even in women without epilepsy, the abnormality figure is 2 to 3%. In consultation with your doctor, an attempt should be made to reduce the number of medicines from two to one at least in the first three months of pregnancy. At the moment you are on the minimal dose of Phenytoin sodium (a good quality brand such as Epsolin should be used); it can be easily increased to 200 mg daily if it results in withdrawal of Divalporex (incidentally Divalporex is nothing but just another name of better known valproic acid or sodium valproate; a slow release formulation such as Valcontin-500 is preferable for 24-hour effect). If possible one, if not two, medicines must be continued during pregnancy. The risk of withdrawal is much more than continuation of the therapy. You must continue folic acid 5mg daily (no benefit accrues with 10 mg since the requirement is about half a milligram; we give more in epilepsy). In addition, 20 mg daily of vitamin K should be taken in the last two weeks of pregnancy and the infant should be given 1mg of vitamin K on birth to prevent bleeding.