Pregnancy and Epilepsy
If I become pregnant, what are my chances of having a healthy baby?
Your chances of having a normal, healthy child are excellent -- greater than 90%. However, there are some increased risks for women with epilepsy that you should consider before getting pregnant, if possible. Both your neurologist and your gynecologist/obstetrician need to be involved in reviewing your antiepileptic drug (AED) and any potential medication changes prior to the beginning of a pregnancy.
Do women with epilepsy have problems getting pregnant?
Overall, women with epilepsy have fewer children than other women. This may be partly personal choice, but research has indicated that women with epilepsy have a higher rate of menstrual cycle irregularities and other gynecological problems that may interfere with fertility. Again, it is important that you talk with your gynecologist/obstetrician and your neurologist to sort through these issues.
What do I have to do to get ready for a pregnancy?
All women should be in good general health and pay attention to their nutrition before and during pregnancy. If finances are a problem, you may qualify for funded nutritional programs such as Women, Infants and Children Supplemental Food Program (WIC). Information about this program can be obtained from your physician's office or from your local health department.
A regular schedule with adequate exercise and appropriate rest will keep you physically fit and may help you manage stress. It is important to take vitamins with folic acid prior to and throughout pregnancy, to reduce the risk of certain kinds of birth defects. Since many of these problems occur very early in pregnancy (sometimes before you know you are pregnant), it is wise to start taking folic acid before becoming pregnant. Check with your physician about the exact dosage.
You may want to ask your physician for a referral to a genetics specialist who can help you assess the risks to your baby from your epilepsy, your seizure medication, and other inherited traits that may be present in your family.
Will my epilepsy cause problems during my pregnancy?
Most women who have epilepsy do not have any unusual problems with their pregnancy.
Studies do show, however, that women with epilepsy have an increased risk of vaginal bleeding both during and after pregnancy. Early and continued prenatal care by your obstetrician is very important. Consistent visits will immediately alert you and your doctor to any problems during your pregnancy and will allow for prompt treatment.
It is very important to avoid tobacco, alcohol, caffeine, and drugs such as marijuana and cocaine. Other dangers may come from environmental chemicals like pesticides, paints and oven cleaners. All of these toxins have been associated with pregnancy complications and poor pregnancy outcomes. By avoiding them, you can eliminate the risk of compounding any negative effects of your anticonvulsant medication.
How can pregnancy affect my seizures?
Most women will see no change in their seizures. One quarter to one third of women with epilepsy who become pregnant will have increased seizures during their pregnancy despite continued use of antiepileptic medication. During pregnancy, concentrations of seizure medication in your bloodstream may change or decrease, putting you at greater risk for seizures. Your physician may need to check blood levels of your medication more often, and may need to adjust your dose. The first two months after delivery are another time when your hormones and your body chemistry may change, affecting levels of your seizure medication. Check with your doctor or nurse about extra lab work that may be necessary.
If I have seizures when I'm pregnant, will they harm my baby?
Although many mothers who have seizures also have perfectly normal babies, seizures during pregnancy can harm the baby.
Generalized tonic clonic (grand mal) seizures can cause miscarriages, although this is a very rare occurrence. Generalized tonic clonic seizures during the last month of pregnancy can cause injury to the baby. If they occur during labor, they reduce fetal heart rate, which can indicate that the baby is in distress. The reason for the heart rate drop is not clearly understood. It is most likely due to a decrease in oxygen because the mother is not breathing adequately, or to a decrease in blood supply during the seizure, or both.
Generalized tonic clonic seizures during pregnancy have not been associated with birth defects. However, one study reported an increased risk for any type of negative effect if the mother had a seizure during pregnancy.
For all these reasons, it is important to reduce the number of seizures you have during pregnancy. Work closely with your doctor, be sure to take your medication as prescribed and avoid those things which may cause you to have a seizure. Notify your neurologist whenever you have a seizure.
However, don't panic if you have a seizure while you're pregnant. Remember, there are many normal, healthy babies born to women who had seizures during their pregnancy.
Is it true that medication taken for seizures may affect my child?
Yes, there may be some increased risk to children of women with epilepsy who are taking seizure medications. In the general population there is a 2-3% chance that a child will have a birth defect (also called a congenital malformation). In women with epilepsy, this risk is increased to 4-8%. In general, there seems to be higher risk if a woman is taking more than one seizure medication, particularly at high doses.
But there are other risks, to both mother and developing child, from uncontrolled seizures. Most women with epilepsy should continue their seizure medication, and whenever possible, take a single AED at the lowest dose that provides seizure control. It is important to work with your health care team to make the best decisions about medications during pregnancy. Remember, you should never stop taking your AED or change the dose without the advice and the supervision of your doctor. It is important to remember that even with the increased rate of certain kinds of birth defects, women with epilepsy who become pregnant have a better than 90% chance of having a healthy baby.
What kind of birth defects might my baby have?
Major birth defects are found more often in the babies of women with epilepsy than in other babies. Examples are cleft lip or palate (portions of the mouth do not grow together properly), heart abnormalities, and neurological problems such as spina bifida (deformities of the spinal cord). Surgery to correct the malformation may be necessary and even then it may not be possible to "fix" the problem completely.
Other problems that may occur are considered minor birth defects and primarily affect the baby's appearance. These can involve facial features, such as wide-set eyes or a short upper lip, or slight differences in the shape of the fingers and nails. These minor abnormalities do not cause any serious problems.
Some research studies have found that women with epilepsy more often have children with small head size, developmental delays, and possibly mental retardation than has been identified in the general population. Other studies don't support this finding. We don't know whether these abnormalities.