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More about Epilepsy and Pregnancy

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Pregnancy is a very important event especially so in the life of women with epilepsy. The main concern in the patient and her relatives mind is whether any thing would happen to the baby is it safe to carry on with the pregnancy. The health of the mother (patient) is also a concern, though to a lesser extent.

During pregnancy, various things to be considered are
  • Risks of baby being born physically or mentally deformed .
  • Risk of epilepsy in the offspring.
  • Risks to mother or baby during delivery.

Risk to the baby does exist, and this would be partly due to the anti epileptic medications and partly due to the seizures themselves, which if frequent, could lead to lack of oxygen to the baby. The risk from medicines is about double (5-6%) when compared to women not on anti epileptic medicines. These take the form of neural tube defects (improper development of brain and /or spinal cord), or facial deformities.

Thus though there is a risk of improper development, this is not too great and most pregnancies pass of uneventfully. Certain medicines like evaporate are known to cause a greater proportion of defects and if possible these need to be changed to some other drug. This has to be done prior to the pregnancy as the risk of fetal defects is highest in first 3 months. Most of the other routinely used medicines have more or less equal risk so there is nothing much to choose between them. Some gynecologists have their individual preferences, as do neurologists, so this decision needs to be taken jointly.

As opposed to risk to baby due to medicines, there are risks of seizures also, and seizures need to be well controlled prior to planning pregnancy. Each seizure causes temporary reduction in oxygen supply to the baby and this may lead to poor growth, or in occasional cases abortions or fetal deaths.

The decision about anti epileptic medicines in pregnancy should be taken before the patient gets pregnant, and pre-pregnancy counseling is an important aspect, which is most often lacking, partly because of the doctors who are not thinking too far ahead and partly due to patients who are too shy to discuss this with their neurologists and prefer to approach the doctor only after pregnancy is confirmed.

Prior to considering pregnancy, the patient’s fits must be controlled and ideally patient should be 6-12 months fit free. This is sometimes a problem because of our society and hence extra counseling is necessary. If the patient is well controlled and on multiple medicines then the doctors try and keep only one of these and reduce the others

If patients are on valproate, then this should be changed to one of the other medicines, always ensuring that the seizure control is not affected. This process may take 3-6 moths. Certain types of fits do not respond to other medicines and there may be no option but to continue valproate. In such cases the doctor tries to keep the dose as low as possible, and the risk of Mal development must be discussed in detail with the patient and husband.

Other measures to be taken during pregnancy are ensuring proper food timings, and sleep; reducing stress. Occasionally the level of the medicines would have to be checked and if too low then dose would be increased accordingly. Folic acid supplements are now routinely used and the help prevent neural tube defects in baby. Period ultrasound examinations also help to detect fetal problems.

During last month of pregnancy there is substantial weight gain and this may lead to the medicine getting diluted. Drug level monitoring often helps to readjust doses, which would continue till delivery.

During delivery (normal or caesarian) the same doses have to be continued. Breast feeding is by and large safe and babies are not affected by most drugs unless the dose is quite high. This needs to be discussed with the doctors. Risk to the mother is negligible, unless patient develops uncontrolled seizures. Or she develops eclampsia (high BP, Swelling of feet, Kidney Involvement).

Lastly, about 5-10% of epilepsies are inherited so that is the risk of baby developing seizures later in life. Epilepsies have many different types and only a few of these are genetic in origin. In any case, treatment of the sits is no different from the non genetic varieties. Even so, it would not mean that the child would be mentally handicapped, and hence this aspect should not be a barrier to considering pregnancy.

All said, pregnancy in an epileptic mother needs careful monitoring and assessment. Though there are increased risks, these are not prohibitive and can be minimized to some extent and most pregnancies pass off uneventfully.

Contributed by
Dr. Hemant Sant
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