A woman with epilepsy can have a baby. With appropriate care and ongoing medical management, most women with epilepsy experience healthy pregnancies and deliver healthy babies.
Planning for Pregnancy
For women with epilepsy considering pregnancy, consultation with healthcare providers is an important first step. This pre-conception counseling, ideally starting several months before attempting to conceive, allows for a thorough review of epilepsy and current medication. Healthcare professionals can assess seizure control and discuss potential adjustments to antiepileptic drugs (AEDs). The goal is to achieve optimal seizure control, ideally being seizure-free for at least six months before conception, while using the lowest effective dose of a single AED if possible.
Many AEDs can impact folic acid levels, which is important for preventing neural tube defects in the baby. Therefore, healthcare providers often recommend a higher dose of folic acid supplementation, typically 4 to 5 milligrams daily, starting at least three months before conception and continuing through the first trimester. Lifestyle factors, such as maintaining a healthy diet, getting enough sleep, and avoiding smoking and alcohol, are also discussed to promote overall health before and during pregnancy.
Managing Epilepsy Throughout Pregnancy
Managing epilepsy during pregnancy involves continuous collaboration with the healthcare team. Physiological changes during pregnancy can affect how the body processes antiepileptic drugs, potentially leading to a decrease in medication levels. This might necessitate adjustments in AED dosage to maintain seizure control, especially for medications like lamotrigine, levetiracetam, and topiramate, whose levels can significantly drop. Regular monitoring of AED blood levels may be recommended, particularly if seizures increase.
Uncontrolled seizures during pregnancy can pose risks to both the mother and the developing baby. Seizures, especially generalized tonic-clonic seizures, can lead to complications such as reduced oxygen to the fetus, slowing of the fetal heart rate, preterm labor, or low birth weight. Falls or injuries sustained during a seizure also present potential harm. While maintaining seizure freedom is the primary aim, the risks associated with uncontrolled seizures generally outweigh the risks associated with continuing prescribed AEDs.
Throughout pregnancy, regular prenatal appointments monitor the mother’s health and the baby’s development. This includes routine ultrasounds, such as a detailed scan between 18-21 weeks, to check for any potential malformations. Healthcare providers also monitor for other pregnancy complications that may have a slightly increased incidence in women with epilepsy, such as preeclampsia or gestational diabetes.
Understanding Potential Risks to the Baby
While most babies born to mothers with epilepsy are healthy, there is a slightly increased risk of certain outcomes. Antiepileptic drugs can cross the placenta and are associated with a higher chance of birth defects, which can include neural tube defects, cleft lip or palate, and heart problems. The risk of major birth defects for women with epilepsy is about 4 to 6 percent, compared to a 2 to 3 percent risk in the general population. This risk can vary depending on the specific AED, its dosage, and whether multiple medications are used. Valproic acid, for example, has been linked to a higher risk of birth defects and developmental considerations, and current guidelines often suggest avoiding its use during pregnancy if possible.
Beyond structural birth defects, there is also a potential for developmental considerations in children exposed to AEDs in the womb. Studies suggest an increased risk of cognitive or neurodevelopmental delays, with valproic acid particularly noted for its association with lower verbal IQ and other developmental problems. However, newer studies show no differences in cognitive outcomes at two years of age between children of women with epilepsy and those of healthy women, especially with medications like lamotrigine and levetiracetam. Factors beyond medication, such as the mother’s seizure control during pregnancy, can also influence developmental outcomes.
Labor, Delivery, and Postpartum Care
Planning for labor and delivery is an important part of managing epilepsy in pregnancy. While many women with epilepsy are concerned about seizures during childbirth, it is uncommon for seizures to occur during this period. Most women with epilepsy can have a vaginal delivery unless there are obstetric reasons for a Cesarean section. Pain relief options like epidurals are generally safe and recommended, as they can help manage stress and promote rest, which can reduce seizure risk. It is important to continue taking AEDs as prescribed during labor, and if oral intake is not possible, intravenous administration may be an option.
The postpartum period is a time of significant physiological and hormonal changes that can affect AED levels and seizure control. Many AED levels, particularly those that increased during pregnancy, may need to be adjusted back to pre-pregnancy doses relatively quickly after delivery to prevent toxicity. Conversely, some women may experience an increased risk of seizures postpartum due to sleep deprivation, stress, and hormonal shifts.
Breastfeeding is generally considered safe and encouraged for women taking most AEDs. Studies indicate that AED concentrations in breast milk and in breastfed infants are often substantially lower than maternal blood concentrations, and serious adverse effects in infants are infrequent. Mothers are advised not to stop their medication to breastfeed. Careful monitoring of the infant for any signs of drowsiness or feeding difficulties is recommended, especially if multiple AEDs are being used.