Women with Epilepsy & Pregnancy
Epilepsy throughout pregnancy raises concern, but most women who have epilepsy deliver healthy babies though they need special care during pregnancy. Here is an excerpt from an interview by Dr G Pavan Kumar Reddy, Consultant Neurologist at OMNI Hospitals, Kurnool on women with epilepsy and pregnancy and its management.
Woman is known to be epileptic presently though not on medication and seizure free from the past 2-3 years, is it necessary to restart her on medication once she plans for pregnancy?
It depends on the type of seizures, number of seizures, family history of seizures and precious pregnancy. Prior history of frequent seizures, family history warrants reintroduction of medication. Most neurologists perform an EEG scan and tailor their decision taking into all the factors.
What is the frequency of seizures in pregnancy?
Most of the times seizure frequency remains the same in pregnancy. Risk of increase in seizures frequency is seen in 10-15% of pregnant women. Increase in risk is usually in first and third trimester.
What are the causes of increase in seizure frequency?
Hormonal changes, sodium and water retention, weight gain, altered metabolism of antiepileptic medications in our body. Most common is decreased sleep and missing medication.
Which women having epilepsy are seizure free during pregnancy?
Women who are seizure free for at least 9 months prior to pregnancy have a less chance of recurrence. It is necessary to discuss with healthcare professionals prior to planning pregnancy.
What are the risks associated with seizures during pregnancy?
Seizures associated with loss of consciousness have the greatest risk to the mother and baby. Injury due to falls can harm both the mother and foetus. Miscarriages, premature labour, slowing of foetal heart rate are noted. Most neurologists opine that risk to mother and foetus due to seizures outweigh the risk due to medication itself.
What is the risk of foetal malformations due to epileptic medications?
Normally in general population the risk of malformations is 2-3% that cannot be prevented or predicated. In epileptic women on medication the risk is 3-5%. But the overall incidence is low. Risk increases with double antiepileptics and higher doses of single antiepileptic.
Is their genetic association with antiepileptics?
Previous pregnancy or family history of congenital malformations raises the risk of malformations during the present pregnancy. Genetic counselling is required.
What are the malformations seen?
Most common are cleft lip and cleft palate. cardiac, spinal cord and urogenital defects are also seen.
Which AEDS carry the highest risk?
Valproic acid, Phenytoin, Carbamazepine.
Which AEDS are relatively safe?
Lamotrigine and Levetiracetam.
What can help lower risk for foetus?
Mother should take folic acid supplementation at least 2-3 months prior to pregnancy. It helps in preventing spinal cord defects. Dosage is 2-4 mg. Enzyme inducing antiepileptic should be supplemented with Vitamin K to prevent bleeding complications in newborn. Obstetricians usually give Vitamin K before delivery.
Important information
- Women should regularly follow up with a neurologist
- Single medication with lowest dose should be maintained that has good seizure control
- Regular blood levels of antiepileptic medication should be checked in pregnancy and medication dose adjusted as per requirement
- Monitoring the baby with USG scan to look for anomalies and checking for alpha fetoprotein (blood level) can help identify anomalies in some
- Epilepsy is not an indication for caesarean section and women can deliver vaginally
- Encourage breastfeeding as the antiepileptic medication in breast milk is very low
Dr G Pavan Kumar Reddy
DM Neurology (NIMS)
Consultant Neurologist
OMNI Hospitals, Kurnool