Epilepsy in Pregnancy

 

I have epilepsy and thinking of getting pregnant soon. What should I do?

Women with epilepsy not surprisingly will be anxious and concern to get pregnant as they worry about the possibility of complications. Studies however, have shown that more than 90% of women with epilepsy go on to have normal pregnancy and good fetal outcome. Nonetheless, epilepsy is associated with several complications, therefore careful planning with your doctor (neurologist and obstetrician) and management of pregnancy could hopefully tip the balance into a more favourable outcome for you and your baby. There are several steps you could take:
  • See your obstetrician and neurologist to make plans for pregnancy.
  • Optimize your epilepsy condition and medication. If you have been fit free for 2 years, there is a possibility, only after discussion with your neurologist to slowly taper down your AED (anti-epileptic drugs) Aim to be on only one AED with the lowest dose which controls the seizures to reduce risk of abnormalities to your baby.
  • If your epilepsy is not well controlled it is best for you to be on suitable contraception until your condition is optimized.
  • Start taking folic acid 3 months prior to conceiving. You may need to take a higher dose of folic acid if you are on certain AED as it may affect the way your body handles folic acid.
  • During the last month of your pregnancy your doctor may prescribe you with Vitamin K to reduce the risk of hemorrhage in your baby.
  • Practice healthy lifestyle e.g stop smoking and drinking alcohol, regular exercise, reduce weight if overweight, have adequate sleep and eat healthy diet.

How will epilepsy affects my pregnancy?

Studies have shown that there is increased risk of growth restriction in the fetus, low birth weight, abnormalities in the fetus, hypertension, placental abruption (premature separation of the placenta from the uterus) and premature labour.1

How will pregnancy affect my epilepsy control?

The frequency of seizure remains the same or is reduced in the majority of women with epilepsy.2 However, about 15 – 30% of women there is an increased in epilepsy frequency. It is important not to stop or adjust your AED by yourself and get enough rest or sleep during pregnancy as all of these factors increases frequency of seizures. Changes in your body during pregnancy may require monitoring of seizures and adjustment in dosage of your AED.

Should I continue taking my anti-epileptic medications?

Yes, provided your doctor has asked you to reduce or stop your medications as the risk of uncontrolled seizure far outweighs the possible risk of abnormalities to your baby.

Could my anti-epileptic medications affect my baby?

There is associated risk of abnormalities with the AED. The risk of having fetal abnormalities in the general population is 2 – 3%. This risk is doubles to 4-6%,3 but overall is still low in those women with epilepsy. Some of the fetal abnormalities include cleft lip or palate (where the lip or roof of the mouth is not completely closed), small baby, small head, delays in growth or development and mental retardation, heart and urogenital abnormalities. The risk seems to be more in those women who require multiple AED and higher dose.

Will my baby have epilepsy as well?

There is an increased risk of your baby having epilepsy as well later on. However the overall risk is still less than 10%
How will my management be during labour?
Seizure during labour is uncommon. Provided you have no other obstetrical indication for a caesarean section and your seizure is well controlled in the last month, you could go through a normal vaginal delivery. Having an epidural to control your pain would be advisable.

Could I breast feed my baby if I am on anti-epilepsy medications?

All of the AED are excreted into the breast milk. However, majority of the experts states that AED is not a contraindication to breast feeding as the benefits far outweighs the risk. However, usage of phenobarbitone, benzodiazepine (sedating effects on the baby) and lamotrigine (extensively excreted into the breast milk) may be the exceptions.

What precautions should I take after delivery?

  • May require adjustment in the dosages of the AED
  • Get enough sleep and rest to reduce risk of seizures
  • Usage of proper contraception as some of the AED may affect the effectiveness of the contraception.
  • Get help from spouse, relatives and friends to take care of your baby. This reduces the stress.
 
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REFERENCES:
  1. Richmond, JR, Krishnamoorthy, P, Andermann, E et al. Epilepsy and pregnancy: An obstetric perspective. Am J Obstet Gynecol 2004; 290:371
  1. Schmidt, D. The effects of pregnancy on the natural history of epilepsy: Review of the literature. In: Epilepsy, Pregnancy and the Child, Janz, D, Bossi, L, Dam, et al (Eds), Raven Press, New York 1982, p.3. 
  1. Meador, KJ, Pennell, PB, Harden, CL, et al. Pregnancy Registries in Epilepsy: A concensus statement on health outcomes. Neurology 2008; 71: 110

     

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