Epilepsy and pregnancy

Epilepsy is a condition that causes abrupt, momentary changes in how the brain functions. When a person has epilepsy, nerve cells in the brain fire electrical impulses up to four times more often than normal, which can lead to seizures (a loss of consciousness accompanied by twitching or thrashing).

More than 90 percent of pregnant women who have epilepsy have uneventful pregnancies and deliver normal, healthy infants. Based on the special concerns related to the condition, however, it's important to plan ahead for pregnancy with your obstetrician and neurologist and receive early and regular prenatal care.


Control of the condition
Pregnancy can be affected by epilepsy and the medications used to treat it. In turn, epilepsy can be affected by pregnancy.
About half of all women who have epilepsy have no change in their seizure control during pregnancy. Some even have better control during pregnancy, possibly because they're more aware of sleep needs and more cautious about taking seizure medications correctly. Up to one-third of women experience an increase in seizure activity during pregnancy, however. This may be due to pregnancy-related nausea and vomiting, which can reduce the amount of seizure medication absorbed or cause you to skip doses. Your body also metabolizes more seizure medication during pregnancy, so levels of the medication in your blood can decrease and trigger a seizure. You may also experience more frequent seizures if you don't take your medication as prescribed, you're stressed or you don't get enough sleep. Seizures during pregnancy can injure both the mother and the developing fetus.


Treatment
Preconception planning
Preconception planning with your obstetrician and neurologist can help you prepare for a healthy pregnancy. It's important to control your seizures as much as possible before conception. To decrease the risk of birth defects, you'll take the safest medication that best controls your seizures at the lowest dose possible. When possible, one medication is preferred over a combination of drugs. If you haven't had a seizure for two to five years, your doctor may suggest stopping the medication to see if you can do without it. This should be done before you plan to conceive, however, as seizures are most likely to occur within the first six months of stopping the medication.

It's also important to begin taking at least 4 milligrams of folic acid every day. Folic acid, a B vitamin, is important in the development of your baby's brain and spinal cord. In fact, it has been shown to help prevent neural tube defects (affecting the brain and spinal cord) for all babies. Folic acid is especially important when you have epilepsy because some seizure medications deplete your body of folic acid, which increases the risk of these defects.

Prenatal care
Early, regular prenatal care is also very important. You will be closely monitored throughout the pregnancy. If you're taking seizure medication, you may need periodic measurement of medication levels and possible dosage adjustments as the pregnancy progresses. To help prevent seizures, it's essential to take the medication precisely as prescribed by your doctor.

Continue taking your folic acid supplement throughout the pregnancy. If you're taking certain seizure medications, you may also need extra vitamin D, which is typically found in prenatal vitamins. During the last month of the pregnancy, your doctor may recommend a vitamin K supplement to help prevent a vitamin K deficiency in your baby. In addition, your baby may be given an injection of vitamin K just after birth.


Considerations
If you're considering breastfeeding, discuss it with your doctor before the baby is born. Breastfeeding is possible for many women who have epilepsy, even though seizure medications do pass into breast milk in small amounts. Some medications may cause excessive sleepiness that leads to poor feeding, but there is typically no noticeable effect on the baby. If you're breastfeeding while taking seizure medication, your baby will be monitored closely.
After the baby is born, contraception with birth control pills may be slightly less effective if you're taking seizure medication. Bleeding between periods may indicate the pill is not working well. Depending on the circumstances, your doctor may recommend a type of birth control pill with a higher dose of estrogen.


Complications
The risk of birth defects in the general population is about 3 percent. Among pregnant women who have epilepsy, the risk is about 7 percent. This increased risk may be due to the epilepsy itself, the medications used to treat it, or a combination of both factors.
The greatest risk of abnormalities occurs during the first three months of pregnancy. Potential problems may include:


neural tube defects, such as spina bifida (which can cause abnormalities in the lower legs, bladder or bowel)
cleft lip or cleft palate (an opening, groove or division in the lip or roof of the mouth)
possible head, face or limb deformities
rarely, abnormalities of internal organs
rarely, mental retardation
If you're pregnant and experiencing seizures, remember that the risks of not taking your medication and having a seizure are greater than the risks associated with the medication. To help determine if your baby has been affected by the medication, the doctor may do an ultrasound (using sound waves to create an image of internal body parts) and an alpha-fetoprotein test (a blood test that can screen for certain birth defects). After the third month of pregnancy, potential adverse effects on the fetus caused by seizure medications are minimal.

Some types of epilepsy can be inherited. As many as 10 percent of children born to women who have epilepsy will eventually develop epilepsy themselves at some point.

Your seizure medications can also cause a vitamin K deficiency in the baby, which increases the risk of bleeding during the first day of life. Women who have epilepsy may be slightly more likely to experience pregnancy complications such as miscarriage, preeclampsia, preterm birth and infant growth retardation.