Epilepsy & Pregnancy
Epilepsy can raise special concerns for women, particularly if you are planning to become pregnant.
While majority of women with epilepsy can become pregnant, you may have certain risks that women without epilepsy don’t have. However with proper management, these risks can be minimized. Over 90% of the women with epilepsy who become pregnant have healthy babies.
How does epilepsy affect pregnancy?
The type of seizures you experience with your epilepsy can cause different degrees of complications. Your provider can provide more specific information based on your history. In general, convulsive seizures pose a higher risk. Risks can include decreased oxygen to the fetus, fetal injury due to fall from a seizure, preterm labor, premature birth. If you haven’t had a seizure for 1 year or more before you conceive, you are less likely to have seizures during pregnancy. Hence the goal is to control seizures before becoming pregnant.
Are Anti -Seizure medications harmful to the fetus?
Women with epilepsy have a 4-6% risk of giving birth to a baby with birth defects compared to 2-3% risk in general population.
Seizure medications can increase the risk of birth defects including cleft palate, neural tube defects, skeletal abnormalities, and congenital heart and urinary tract defects. Your provider can provide you with information about risks associated with your medications. Some seizure medications interfere with the folic acid levels in blood. For most women, taking seizure medications at risk of neural tube defects, at least 4mg of Folic acid supplementation daily for a period of three months before becoming pregnant is recommended. Ask your provider if folic acid supplementation would be beneficial for you.
How should I plan for pregnancy?
You should start your discussion with your provider at the time of your initial visit or periodically even if you are not planning to become pregnant. Planned pregnancies are usually the best ways to approach. This gives you sufficient time to discuss and work with your providers. Get a health care provider to work with you before, during and after your pregnancy – particularly an obstetrician who is comfortable with epilepsy and an epilepsy specialist. Review your seizure medications and seizure control with your epilepsy specialist before pregnancy. If you experience frequent seizures before conception, you might be advised to wait to get pregnant until your seizures are under control.
For most women taking seizure medications at risk of neural tube defects, at least 4mg of Folic acid supplementation daily for a period of three months before becoming pregnant is recommended. Ask your provider if folic acid supplementation would be beneficial for you. Make healthy life style choices – such as getting adequate sleep, avoiding smoking and alcohol, exercise and eating healthy diet
Some women can have more seizures during pregnancy mostly in the first and third trimester due to hormonal changes and fluctuating seizure medication levels or other issues. So, plan for frequent visits with your epilepsy specialist.
Pay attention to seizure triggers and healthy living. If recommended by your provider, continue to take folic acid and prenatal vitamins. Continue to take your seizure medications as prescribed. Do not make any changes without consulting your doctor. If you have a seizure, especially during in the last few months of pregnancy, inform your providers. They will closely monitor you and your baby.
Labor and child birth can put a tremendous stress on the body and can cause increased risk of seizures. Contributing factors may include poor sleep, physical pain and failure /inability to take seizure medications. It is important to get plenty of rest and minimize or avoid stress. Take help from friends and family members. Be sure to take your seizure medications as recommended by your provider.
Can I breastfeed if I am taking anti-seizure medications?
Breast feeding is usually possible and recommended. Most anti -seizure medications are secreted in breast milk in small amounts. It is now well accepted that in most cases, the benefits of breast milk are far more important. Discuss this with your provider in advance.