A 26-year-old woman with epilepsy stabilized on phenytoin tells the nurse she plans to become pregnant in the next year. Which is the nurse's priority response?

Correct (2): Phenytoin is <span class="merci-kw-mark">teratogenic</span> — fetal hydantoin syndrome (cleft lip/palate, congenital heart defects, growth retardation) and increased neural tube defects. <span class="merci-kw-mark">Preconception counseling</span> is essential: switch to safer agent (e.g., lamotrigine, levetiracetam) and start <span class="merci-value-normal">4-5 mg folic acid daily</span> at least 1 month before conception. (1) Not safe. (3) Abrupt discontinuation risks status epilepticus, which is dangerous to mother and fetus. (4) False — pregnancy does not cure epilepsy and often worsens it.

In-depth explanation

<span class="merci-scenario-label">Memory Tip</span> Anticonvulsants in pregnancy — safest: <span class="merci-value-normal">lamotrigine, levetiracetam</span>. Most teratogenic: <span class="merci-value-normal">valproate</span> (NTD, autism), <span class="merci-value-normal">phenytoin</span>, <span class="merci-value-normal">carbamazepine</span>, <span class="merci-value-normal">topiramate</span>.

Clinical scenario

<span class="merci-scenario-label">Scenario</span> 26-year-old female, seizures well controlled on <span class="merci-kw-mark">phenytoin 300 mg daily</span>, plans pregnancy in 6-12 months. Currently on no other medications.

Key concepts

• Teratogen — A substance causing fetal malformation; phenytoin, valproate, carbamazepine are anticonvulsant teratogens.
• Preconception counseling — Pre-pregnancy planning visit to optimize chronic disease therapy and start folic acid; mandatory for women with epilepsy on teratogenic medications.
• Fetal hydantoin syndrome — Cluster of cleft lip/palate, cardiac defects, and growth retardation from in-utero phenytoin exposure.