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Most women with epilepsy have healthy babies and the risks involved in their pregnancies are the same as for any pregnancy.
Women
with epilepsy, however, should be
aware that there are special
considerations related to pregnancy.
If at all possible, a woman who has
epilepsy should consult with her
doctor before becoming pregnant to
plan for the healthiest possible
pregnancy.
Pregnancy
can affect the way your body is
using your seizure medication and/or
it could affect the pattern or
frequency of your seizures. There is
also a slightly higher risk that
having epilepsy and/or taking
seizure medication will affect the
fetus.
Frequently
asked questions regarding pregnancy
and women with epilepsy.
Will
I have difficulty getting pregnant?
While women with epilepsy have fewer children and a lower fertility rate than those in the general population, there has been an increase in pregnancies in women with epilepsy in recent years. Likely this increase has been influenced by both the improved control of seizures and a better understanding of epilepsy resulting in an increasing numbers of women with epilepsy developing relationships.
Personal choices as well as a higher rate of menstrual irregularities and other gynecological problems resulting from seizure medication are likely also factors in the lower rate of pregnancies in women with epilepsy.
The temporal lobe of the brain is associated with the areas of the brain that regulate hormones in the body. If a woman experiences seizures that occur in the temporal lobe, there appears to be a higher incidence of reproductive disorders such as polycystic ovaries (many cysts on the ovaries), early menopause, and irregular or no ovulation. All of these conditions could make getting pregnant more difficult.
Seizure medication can also affect how the body regulates hormones. This can also result in reproductive changes in the body.
Do
seizures change during pregnancy?
Most
women have no change in seizure
frequency during pregnancy. Some
even have a reduction in seizures.
Others
do, however, experience an increase
in seizures when they are pregnant.
With
the physical changes that occur in
the body during pregnancy, seizure
medication levels in the blood may
fluctuate resulting in a change in
seizures. Other factors that can
affect seizures during pregnancy
include:
-
higher estrogen levels during pregnancy
-
an increase in situations that are known to trigger seizures such as higher stress levels and loss of sleep
-
a reduction in seizure medication due to a woman’s concern over the possibility of harmful effects to the fetus. Changes in seizure medication should only be done on your doctor’s advice as the risks associated with uncontrolled seizures are higher than those associated with taking seizure medication.
Is
there a greater risk of complication
during pregnancy?
Yes,
complications during pregnancy and
labour are slightly higher in women
with epilepsy. Both seizure
medication and uncontrolled seizures
pose risks during pregnancy. The
risks associated with uncontrolled
seizures are considered to be higher
than those associated with taking
seizure medication.
While most seizures do not have harmful effects on the fetus, having a tonic clonic seizure can increase the risk of miscarriage, trauma to the abdomen, and/or oxygen deficiency to the fetus.
In
women with epilepsy, there is also a
small increase in the risk of
premature labour and delivery,
morning sickness, vaginal bleeding,
and placental detachment. There is
also a slight increase in fetal loss
late in the pregnancy, stillbirths,
and the need for a caesarean section
in women with epilepsy.
In general, however, a woman with epilepsy will have a normal pregnancy, labor and delivery.
Having a seizure during delivery is generally not dangerous but it may result in a more difficult delivery. It is recommended that you continue to take seizure medication up to the time of and during labour. It is important that you take your seizure medication with you to the hospital in case of a lengthy labour and that you inform staff on the hospital ward that you have epilepsy.
The
risk of a baby developing internal
bleeding within the first 24 hours
after birth is also slightly higher
if the mother has epilepsy and is
taking certain seizure medication.
The risk of this occurring is low
and doctors often prescribe vitamin
K in the weeks prior to delivery as
a preventative measure. Often
newborns are given vitamin K
following birth to ensure proper
blood clotting.
Are
seizure medication levels affected
by pregnancy?
With physical changes in the body during pregnancy, seizure medication levels may decrease during pregnancy. Reasons for this include water retention that can create an increased volume of distribution, a faster metabolism, a decrease in absorption, and faster clearance from the body. Frequent blood tests to monitor the drug levels in your blood may be necessary.
Seizure
medication levels can also be
influenced by hormonal change during
the postpartum period following
delivery. It is important that blood
levels continue to be monitored
following pregnancy as well.
Can
seizure medication harm the fetus?
Some types of seizure medication can carry the risk of causing harm to a fetus. Polytherapy, or treatment using more than one seizure medication, has a higher risk of causing harm than does monotherapy, or the use of one seizure medication.
In
recent years, however, there has
been a decrease in the risk of birth
defects in children of women with
epilepsy. This has been partially
attributed to an improvement in the
available seizure medication, a
decreased use of polytherapy in the
treatment of pregnant women, and an
increased use of folic acid as
prescribed by the doctor. Folic acid
is thought to prevent birth defects
and is recommended for all women of
childbearing age.
As
the greatest risk of possible birth
defect occurs in the first trimester
of pregnancy, it is advised that you
talk to your doctor prior to
becoming pregnant.
Harmful effects of seizure medication to the fetus could occur in the early weeks of pregnancy before pregnancy is medically confirmed. Planning for pregnancy will allow you to work with your doctor to establish the best possible treatment for the health of both you and your baby.
If
you discover that you are pregnant
and have not discussed this with
your doctor, do so as soon as
possible. Changes in seizure
medication and/or dosages as well as
vitamin supplements may be may be
required.
It
is essential that you continue to
take seizure medication as
prescribed by your doctor during
your pregnancy. Sudden
discontinuation of medication can
result in withdrawal seizures or
status epilepticus, a
life-threatening condition, and the
risks to the fetus of having
uncontrolled seizures are considered
to be higher than those associated
with taking prescribed seizure
medication.
Following
birth, babies sometimes experience
withdrawal symptoms from the
mother’s seizure medications but
these symptoms typically wear off
over a few days or weeks and do not
cause long-term effects.
If
I have a seizure, will it harm the
fetus?
While
evidence suggests that having brief
seizures or partial seizures do not
harm the fetus, a prolonged seizure
carries the risk of causing harm.
For
example, having a tonic clonic
seizure can increase the risk of
miscarriage, trauma to the abdomen,
and/or oxygen deficiency to the
fetus.
Will
my baby be healthy?
In general, women with epilepsy have a greater than 90 percent chance of having a healthy baby.
There is, however, a greater risk of having a child with a birth defect in women with epilepsy than in the general population. The rate is 2 to 3 percent of having a child with a birth defect in the general population, and 4 to 6 percent in women with epilepsy who are being treated with seizure medication during pregnancy. The percentage may be higher if a woman with epilepsy is taking more than one seizure medication.
This increased risk of having a child with a birth defect may be the result of a number of factors including the effects of seizure medication and the influence of inherited genetic traits. Seizures can also harm the fetus.
Though rare, birth defects can include major malformations such as spina bifida (or malformation of the spinal cord) or other neurological problems, heart abnormalities, and cleft lip/ palate. Minor malformations such as differences in the shape of fingers or widely spaced eyes can also occur.
All women should avoid alcohol, street drugs, and cigarette smoking during pregnancy.
Will
my child have epilepsy?
There is only a slightly higher risk of a child developing epilepsy if a parent has epilepsy. The risk of a child having unprovoked seizures is one to two percent in the general population and approximately six percent if a parent has epilepsy.
Can
I breast-feed?
Breast-feeding is generally safe and recommended for women with epilepsy. Seizure medication levels in the breast-milk tend to be of low concentration with no adverse side effects.
Some seizure medications, however, can cause drowsiness or irritability in a breast-fed baby and your neurologist or obstetrician may recommend that breast-milk be supplemented with bottle feedings.
It is important to discuss breast-feeding with your doctor to establish the healthiest approach for your child.
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