September 17, 2014
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Family & Child

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Epilepsy and pregnancy

What happens if I have epilepsy and become pregnant?

About one third of the population with epilepsy are women of childbearing age. Among women who are pregnant, about 1 in 200 have epilepsy. Fortunately, most of these women deliver healthy babies.

What are the risks of epilepsy to an expectant mother?

Generally speaking, most women experience no change in the frequency and severity of seizures during pregnancy. Some women may experience an increase or a decrease in the number of seizures.

What is the risk of epilepsy to a baby?

Firstly, the developing baby is at some risk from direct trauma to the mother's abdomen sustained during a major seizure. There is also the risk of a temporary lack of oxygen to the fetus brought on by a major maternal seizure. A minor seizure, without falling or any type of convulsive element, is very unlikely to cause harm to the developing baby.

Another area of concern is that anti-epileptic drugs (AEDs) can cause birth defects ranging from mild (e.g., cleft lip, slight shortening of the fingers), to severe (e.g., major heart defects, neural tube defects such as spina bifida). Those abnormalities, as well as others, occur in about 2% to 3% of babies born to healthy, medication-free non-epileptic women. This risk increases to about 4% to 8% in epileptic women taking AEDs. Thus the risk is small but tangible.

Is it wise to stop epilepsy medication during pregnancy?

Stopping medication gradually under medical supervision can be considered a safe option for some women. For most women who have epilepsy, they should continue to take their seizure medication up to the time of and during labor. The risk of uncontrolled seizures is higher than the risk of taking any AED. Fortunately, more is known about the way AEDs can be used during pregnancy to help reduce the risk linked to its use. Talk to your doctor about any concerns you have and do not stop taking your medication before consulting with your doctor.

Is there anything else I can do to prevent fetal malformation from medication?

Daily folic acid supplementation prior to becoming pregnant and during pregnancy may reduce the risk of birth defects. Folic acid is recommended to all women throughout their childbearing years, whether or not they are pregnant or plan to get pregnant.

Do some AEDs harm the baby less or more than others?

Certain AEDs, such as valproate, and taking more than one AED, appear to carry a higher risk of causing harm to the baby during pregnancy. Talk to your doctor about the risks and benefits of using valproate or multiple anti-epileptic medications during pregnancy. You should not stop or switch medications without speaking to your doctor first.

What tests can I have when pregnant, to know if my baby has been harmed by AEDs?

Maternal blood testing at around 16 weeks can help establish that the developing fetus is healthy and without major defects. This is done by screening the mother's blood for three special markers. This test is called triple marker screening or TMS for short. The test is not perfect; whereas a negative screen does not guarantee a normal baby, it is correct 99% of the time. A positive screen result for fetal deformity can be followed by amniocentesis (analysis of fluid from the birth sac), and fetal ultrasound examination, for detection of defects.

Can I breastfeed and still be on AEDs?

In general, breast-feeding is safe and recommended for women on AEDs. For many AEDs, only a small amount passes into breast milk. However, there are some AEDs that can still cause drowsiness or irritability in a breast-fed baby. See your doctor to discuss the best approach for your baby.

What is the bottom line?

or most women, it is better to carry on with AED treatment before and during a planned pregnancy. Although the baby can be harmed by medication, this risk has to be set against the damage to the developing baby from an uncontrolled seizure or (worse still) a series of seizures not covered by medication. It is really a question of which risk is the smaller one. Continuing with an AED usually wins out.

In conclusion, although there are certain risks to an epileptic mother and her developing baby, those risks are relatively small and are not insurmountable. The fact of the matter is that given good care, a healthy infant is produced in more than 90% of pregnancies occurring in women with epilepsy. The decision whether or not to conceive is clearly a personal one that should be discussed in full with one's partner and personal physician.

 
Peter M. Rees, PhD, MD,
 
in association with the MediResource Clinical Team 

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