When a woman with epilepsy is seizure-free and planning pregnancy, measure her antiseizure drug trough level and record it prominently as her individual target. Population reference ranges are wide and many women are well controlled below them. Once pregnancy begins, that personal baseline is the number to defend: if levels fall more than about a third below it, a dose increase is usually warranted. The same record makes post-partum dose reduction safer, because you know where you are returning to.
- Measure a trough level when the woman is seizure-free before pregnancy.
- Record it as her personal target in the notes and antenatal record.
- Adjust the dose in pregnancy against that personal target, not the laboratory range.
- Use it to guide stepwise dose reduction after delivery.
Why it matters
Without a personal baseline, a falling level in pregnancy cannot be interpreted.
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