There is a complex interaction between epilepsy, antiepileptic medicines, and pregnancy. Epilepsy and antiepileptics can affect pregnancy and vice versa. Anybody who has seizures will be afraid how pregnancy is going to be, and above all how the disease and its treatment will affect the baby.
Conceiving may have been a dream come true for you. Women with epilepsy have several reasons to have a lower fertility. Epilepsy is associated with menstrual irregularities and several disorders that disrupt the hormonal balance of the reproductive phase. Alternatively, you may have conceived accidentally. You were on oral birth control pills and your epilepsy was well under control with medicines. You do not remember missing your pill and you have religiously been taking all your medicines. You are confused how you could have gotten pregnant and are now worried about the effects of your antiepileptics on your baby. This is no paradox! Antiepileptics interact with and reduce the effectiveness of birth control pills.
Pregnant and epileptic
It is a risk to get pregnant if you have epilepsy. You should go in for preconception counseling with your gynecologist, neurologist, and midwife. Discuss your epilepsy, its control, prevention, possible complications, and risks to the baby. If you have been planning to have a baby and have not had any episode of epilepsy for many years, your health professional can gradually take you off your antiepileptics before you conceive. Never try to stop or reduce your dosing by yourself.
If you are already pregnant, you should keep taking your seizure medicines as usual, start taking folic acid, and see your health professional as soon as possible.
Pregnancy affects seizures. Hormonal and other body changes in pregnancy can change the concentrations of the antiepileptics in blood, and hence pose a greater likelihood of seizures. Up to 1/3rd women with epilepsy have increased frequency of seizures when pregnant.
Pregnancy can be more troublesome in women with epilepsy. These include excessive vomiting, vaginal bleeding, anemia, premature labor, non-progressing labor, and increased tendency to surgical deliveries. There is a greater risk of falls and injuries, abortions, increased blood pressure, and detachment of the placenta, an organ that connects the baby to the womb.
Most women with epilepsy will deliver healthy babies through a natural process of labor and may be given pain control during labor like in any usual pregnancy. A hospital delivery is better. If you develop an episode of seizures during labor, you will need antiepileptic medicines to be infused into blood. Otherwise, you should continue your regular medicines during labor.
Risk to the baby
Epilepsy in pregnancy poses risks for the growing baby. There is a risk of miscarriage and retarded growth of the baby in the womb. If you suffer from an episode of seizures when in labor, your baby may have a low supply of oxygen and go into distress. The heart rate of the baby may start falling. Epilepsy per se does not increase the risk of birth defects in the baby. Your baby may be born before term of pregnancy is completed, may be low in birth weight and have a higher risk of bleeding and jaundice in the first few days of life. Worst of all, the baby may die in the womb.
Antiepileptic medicines pose a risk of malformations to your baby. These include birth defects in the organs like spine, brain, heart, limbs, facial features, or other organs. Some medicines are more notorious than others to cause these defects. Some can cause fetal anticonvulsant syndrome (FACS) that comprises developmental or learning difficulties and behavior problems as the child grows.
Protect yourself and the baby
You should protect yourself from epilepsy and its adversities. The best approach is to keep your seizures under control. Take medicines as advised by your health professional. You may need to switch to other drugs or adjust amount and timings of doses. It is best to use a single drug, in the lowest possible dose, and adopt multiple dosing regimen. There is no best drug. Your doctor will select the safest one for you. As pregnancy advances, the changes in your body will necessitate frequent dose adjustments. Remember! Uncontrolled epilepsy can do more harm than any antiepileptic drug.
You will need to protect your baby. While you are planning to get pregnant, start taking folic acid, i.e. vitamin B9. A dose of 0.4 mg per day is advised for women before conception and at least up to 12 weeks of pregnancy. In epileptics, this dose may be increased to 5 mg per day. This helps to prevent malformations of the nervous system, brain, spine, and others.
You will need to take vitamin K, 10 mg daily, in the last month of pregnancy. If not the oral form, you may need two injections of 10 mg of vitamin K in the 34 and 36 weeks. Antiepileptics can reduce the total vitamin K which control bleeding mechanisms. As a result the baby may develop bleeding problems called ‘hemorrhagic disease of newborn’. Vitamin K prevents bleeding. The baby should be given 1 mg of vitamin K after birth.
You should take proper rest and moderate exercise, avoid triggers of epilepsy, eat a healthy diet, and take vitamins and medicines regularly.
During Pregnancy
Managing epilepsy and pregnancy can be challenging. You will need frequent consultations with your doctor to adjust the drug dosages and monitor the growth of the baby. You may have to undergo some additional tests. These include alpha fetoprotein (AFP) measurement in blood and ultrasound examinations. AFP is a protein produced in excess if there is an anomaly in the developing baby. It may also be measured in the amniotic fluid, the waters that bathe the baby in the womb. A sample of the amniotic fluid may be obtained with a syringe through your belly, a process called amniocentesis. Ultrasound shows any major malformations of the baby. An echo of the heart of the baby may be done.
You may breast feed your baby though antiepileptic medicines are secreted in breast milk. Watch your baby consistently. If the baby gets drowsy, hyperexcitable, or irritable, contact your health professional.
Outlook
Your child may inherit epilepsy from you, if the underlying cause is a genetic disorder. Some reports of higher risk of epilepsy in children born to epileptic mothers do exist. Relax! Chances are high that you have a normal baby. Care and caution when pregnant can help you to mitigate the risks and have a healthy baby.
