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Managing epilepsy becomes more challenging during pregnancy because these seizures and some treatments can affect the unborn baby. However, most individuals with this condition can have healthy pregnancies when closely monitored by healthcare professionals.
Planning for Pregnancy with Epilepsy
Proper planning before you conceive is important for a healthy pregnancy. It helps you and your doctor manage your epilepsy effectively and reduce risks for your baby.- Consult your healthcare professional: Before trying to get pregnant, meet with your neurologist or a high-risk pregnancy specialist. They’ll assess how well your epilepsy is controlled and discuss any medication changes. If your seizures are frequent, they may suggest waiting until your condition is better managed.
- Review medications: Some anti-seizure medications (ASMs) can affect fertility or increase risks for your baby. Your doctor may adjust your dose or switch you to safer options, which have lower risks during pregnancy. Never stop or change your medication without medical advice because uncontrolled seizures can be dangerous.
- Start folic acid: It can help reduce the risk of neural tube defects in your baby. You will need to take 400 mcg of folic acid daily at least one to three months before trying to conceive. Your doctor might recommend a higher dose depending on the severity of your epilepsy. If you get pregnant unexpectedly, begin supplementation and contact your doctor immediately for the right dosage.
- Use contraception until ready: Continue using effective contraception until you discuss your pregnancy plans with your doctor. This is especially important if you’re on medications like sodium valproate, which carries higher risks.
- Understand risks and benefits: Over 90 per cent of individuals with epilepsy have healthy babies. But there’s a small increased risk of birth defects due to ASMs, particularly with polytherapy or high doses. Preconception counselling helps you weigh these risks and make informed choices.
Epilepsy During Pregnancy
Pregnancy can affect your epilepsy in different ways. Likewise, epilepsy can influence your pregnancy too. For most individuals, seizures stay the same or might decrease. But stress, sleep deprivation, or missed medication can increase seizures during pregnancy. Individuals with focal epilepsy or on polytherapy may have a higher risk.High oestrogen levels during pregnancy can also increase seizure risk by lowering the seizure threshold. However, progesterone helps prevent these episodes by producing a protective anticonvulsant effect through a substance called allopregnanolone. These hormonal changes can affect how seizures occur.Risks of Seizures During Pregnancy
Seizures during pregnancy can cause certain complications, including:- Slowed foetal heart rate
- Maternal and foetal hypoxia
- Preterm labour or premature birth
- Low birth weight
- Trauma (like falls) that could lead to placental abruption or foetal loss
- Acidosis
Catamenial Epilepsy
About 30 per cent of individuals notice seizures tied to their menstrual cycle, called catamenial epilepsy. They are more likely to occur during ovulatory cycles than anovulatory cycles, often at the start of menstruation or around ovulation (day 14 or 9). It is important to manage your epilepsy during these days if you are trying to conceive and improve your chances of a healthy pregnancy.Epilepsy Medications and Their Risks During Pregnancy
Anti-seizure medications are necessary to control seizures, but some carry risks for your baby. Certain ASMs increase the risk of major congenital malformations and other issues. These include:- Valproate: It carries the highest risk of birth defects, including spina bifida, cleft palate, heart defects, hypospadias, polydactyly, and craniosynostosis. Risk increases with doses above 800 mg. It is also linked to lower IQ and a higher chance of autism spectrum disorder and intellectual disability in children.
- Topiramate: Risk of microcephaly and small-for-gestational-age babies.
- Phenobarbital and phenytoin: Risks linked to heart and skeletal issues.
- Carbamazepine: Reduce vitamin K levels in the foetus, which might lead to a bleeding disorder.
Polytherapy Risks
Taking multiple anti-seizure medicines, especially with valproate or topiramate, increases malformation risk compared to monotherapy. However, this risk can be reduced when these two drugs are excluded from the polytherapy treatment.Pregnancy Complications
Epilepsy and ASMs can affect your ability to conceive and the health of your pregnancy. You may have lower fertility, especially with polytherapy or phenobarbital use. A few complications you might face include:- Higher rates of caesarean section.
- Increased risk of preterm birth, low birth weight, small-for-gestational-age babies, and smaller head circumference.
- Risks of spontaneous miscarriage, antepartum haemorrhage, hypertensive disorders, and induction of labour.
Prenatal Care and Monitoring
Regular prenatal care is important for you and your baby’s health.- Frequent checkups: You’ll have regular visits to monitor your weight, blood pressure, and ASM levels. Extra ultrasounds and tests may track your baby’s growth and development.
- Screening for malformations: Between 12 and 18 weeks, detailed ultrasounds can detect major congenital malformations. Discuss screening outcomes and next steps with your doctor beforehand.
- Vitamin K supplementation: If you’re on enzyme-inducing ASMs, your baby may receive a vitamin K injection at birth to prevent bleeding issues. Pregnant individuals with epilepsy who are using anti-epileptic drugs are advised to take vitamin K 10 mg by intramuscular injection at 34 and 36 weeks of pregnancy.
Labour and Delivery
Most individuals with epilepsy have uncomplicated deliveries, but planning for a safe birth is important.- Delivery in a well-reputed hospital is recommended: Deliver in a consultant-led maternity unit where doctors can monitor you closely. Bring your ASMs to the hospital and take them as prescribed.
- Seizure management: Seizures during labour are rare but can be treated with certain medications prescribed by your doctor. Prolonged seizures may require a caesarean section to protect you and your baby.
- Post-delivery medication: If your ASM dose was increased during pregnancy, it may need to be reduced after delivery to avoid toxicity as blood levels rise postpartum.
Breastfeeding and Postpartum Care
Breastfeeding is generally safe if you have epilepsy. However, some experts advise caution for individuals who are taking phenobarbital, primidone, clobazam, or clonazepam. They recommend closely monitoring the baby for signs of lethargy or poor feeding.Tips for Safe Breastfeeding
- Nurse before taking your ASM dose to minimise drug levels in milk.
- Use expressed milk at night to reduce sleep deprivation, which can trigger seizures.
- Position yourself safely to avoid dropping your baby during a seizure.
Neuromodulation Treatment for Epilepsy in Pregnancy
Devices like vagus nerve stimulation, responsive neurostimulation, and deep brain stimulation appear safe during pregnancy, with no increased risk of malformations. However, data is limited, and more research is needed.Prior planning and medical guidance can make a big difference if you have epilepsy and want a safe pregnancy. The right medication and regular checkups help reduce the risk of seizures that could harm you and your baby. So stick to your treatment plan, get enough rest, and stay in touch with your doctor throughout pregnancy and after birth.FAQs on How to Manage Epilepsy During Pregnancy
- Can I have a healthy baby if I have epilepsy?Yes, most people with epilepsy can have healthy babies, especially with proper planning and medical care.
- Should I stop taking my epilepsy medication when I get pregnant?No, never stop or change your medication without medical advice. Uncontrolled seizures can harm you and your baby.
- Is it safe to breastfeed while taking anti-seizure medications for epilepsy?Yes, breastfeeding is usually safe. Just monitor your baby closely and nurse before your next medication dose to reduce drug levels in milk.