Epilepsy and Pregnancy - With Her in Mind
Epilepsy & Pregnancy
Most of these women will have a normal pregnancy and delivery, an unchanged seizure frequency and over 90% chance of having a healthy baby.
If you have epilepsy, it doesn't necessarily mean that starting a family will be any more difficult for you than for anyone else. However, it may mean that you have a few more things to consider before, during and after your pregnancy.
This booklet looks at the issues around pregnancy and parenting that may affect some people with epilepsy.
There are many fears and anxiety associated with pregnancy in a woman who has epilepsy. However, it should be noted that over 90% of women with epilepsy have a normal pregnancy. Nonetheless, there are a number of foetal and obstetrical complications associated with women with epilepsy. It is important for women with epilepsy to be aware of these, as careful planning and management of pregnancy can increase the odds of a favourable outcome.
1. What is Epilepsy?
Our brain is a complex organ made up of many specialized brain cells. These brain cells perform electrical activities, which occur in a normal pattern and are responsible for the normal functioning of the brain and the body.
Epilepsy is a disorder of the brain cells where there is a recurrent, sudden and episodic burst of excess electrical activity, resulting in a change in the behaviour of the person. This may be due to specific medical condition, injury to the brain or unknown causes.
However, a seizure is one single episode of such a change in electrical activity, which may or may not be related to epilepsy.
2. I have Epilepsy. Can I have Children?
Many people with epilepsy have children and a normal family life. Having epilepsy doesn't usually make it harder for a woman to get pregnant. However, anxieties around having epilepsy, taking medication and the possibility of seizures can all affect how you may feel about trying to start a family.
Some women with epilepsy have irregular periods or a condition called polycystic ovarian syndrome (PCOS). PCOS is more common in women who put on weight, and some anti-seizure drugs have weight gain as a possible side effect. PCOS is treatable, but it can make becoming pregnant little difficult. However, many women with PCOS successfully become pregnant with appropriate measures. Consult your doctor for further advise.
Although you may be concerned that anti-seizure drugs might affect your chance of becoming pregnant, it is important never to stop taking antiseizure drugs suddenly and without the medical guidance of your doctor.
3.Can Women with Epilepsy have a Normal Baby?
Over 90% of babies born to women with epilepsy are normal and healthy. However, some drugs, if not all, increase the risk of malformations and, therefore, there are certain chances of having a baby born with a birth defect. The good news is that with appropriate anti-seizure medication, it is possible to have normal babies. So, it is important to visit your doctor and let him/her decide what is best for you and your baby.
4. Is it Important to See My Doctor Before I Try to Become Pregnant?
It is very important to talk with your doctor before you plan to get pregnant. That way, your doctor has enough time to check your anti-seizure medicine and change it, if required. In some women, the type of anti-seizure medication may need to be adjusted or changed to reduce any possible risk of affecting the baby growing in the womb. In a few women, their drugs might need to be changed in order to control their epilepsy better. All women who are taking anti-seizure medications and who are trying to become pregnant should take folic acid daily to reduce the effects of the epilepsy drugs on the baby's development in the womb.
5. What If I am Already Pregnant ?
As many pregnancies are unplanned, some women don't have the chance to talk through these concerns and make any necessary changes. If you become pregnant without having the chance to have some preconception counselling, it is recommended that you keep taking your anti-seizure medications as normal and start taking folic acid supplements. It is also recommended that you make an appointment to see your doctor as soon as possible.
6. If I Become Pregnant, Will I have More Seizures?
Most women will see no change in their seizures. However, there are women who might face an increase in the frequency of seizures.
This is because of the following:
- During pregnancy, there is an increase in the volume of fluids in the body in order to accommodate the growing baby. Thus, the normal doses of drugs become insufficient to control seizures.
- In some women, pregnancy might alter the way their body deals with the drugs, making their levels low in the blood. In these women, the drug levels in the body need to be adjusted.
- Also, hormonal changes in the body during pregnancy can lead to fluctuations in the level of anti-seizure medication. This phenomenon can also increase the frequency of seizures.
- In some women, frequent vomiting during the initial phases of pregnancy (also called as morning sickness) might lead to a decreased uptake of these drugs in the blood. Appropriate anti-vomiting medications are needed in these cases.
- Lack of sleep and physical strain in late pregnancy.
- Last but not the least, skipping anti-seizure medications is an important cause of increase in seizure frequency.
Your chances of having more seizures can be reduced by achieving good seizure control before pregnancy, getting plenty of sleep during pregnancy and carefully taking your medication. Consult your doctor for dosage changes or drug modifications for better control of your seizures during pregnancy.
7. Will My Epilepsy Cause Problems During My Pregnancy?
Most women who have epilepsy do not have any unusual problems with their pregnancy.
However, women with epilepsy have an increased risk of vaginal bleeding both during and after pregnancy. All women with epilepsy should be looked after by a team of doctors who can handle her delivery and her seizures. In some women with poorly controlled epilepsy, the labour may need to be started off earlier; in some women, they may need a caesarean section. In most women with epilepsy, the risk of serious seizures in labour is very low and they will have a normal delivery.
8. Will I have to Undergo Specific Tests During My Pregnancy?
Yes. You will have tests to check your baby's health. These can include blood tests and an imaging test called an ultrasound. An ultrasound creates pictures of your baby. You might also need to have blood tests to check the amount of anti-seizure medicine in your body.
9. Will I be Able to Breastfeed My Baby If I'm Taking Anti Epileptic Medication?
Yes! Breastfeeding is possible and safe in most women taking anti-seizure medication. The levels of the drugs found in breast milk tend to be lower than those in the mother's blood, so the amount of drug the baby has with breast milk is usually less than it was having when it was in the womb. The small risks involved in breastfeeding should always be balanced against the well-proven and many advantages of breastfeeding over bottle-feeding.
10. What are the General Measures I Can Observe in Order to Have a Healthy Baby?
In order to minimize the risks to you and your baby, you need to do everything possible to maximize the chances of a normal pregnancy and delivery.
- Make pre-pregnancy and follow-up appointments with your doctor. It will help to plan for a risk-free and safe pregnancy.
- Remember to take the medication as prescribed. Let your doctor decide what medication plan is best for you.
- Anti-seizure medication intake has to be insured.
- Report all seizures to the doctor.
- Supplementation of vitamin K in pregnant women taking certain anti-seizure medications in order to prevent blood related problems in the newborn.
- Concentration of medicines in the blood should be regularly checked. Before you start or stop medicine, it is always best to speak with the doctor who is caring for you while you are pregnant.
- Do not consume any other medication for any purpose without consulting your doctor. It may be harmful to the foetus as well as your seizure control.
- Ensure that the doctor recommends tests to ascertain the health of your baby. These tests include an ultrasound (USG or sonography) at regular intervals to monitor the growth of your baby and check for any possible defects in the child's heart and brain. This will help you to understand the chances and make important decisions about your pregnancy and the health of your child.
- Consult your doctor for nutritional supplements like folic acid.
- Avoid stress, and get plenty of rest and sleep.
- Have a good, nutritious diet.
- Avoid alcohol, smoking and caffeine.