Epilepsy and Pregnancy

Disclaimer: I am not a medical professional and you should always discuss any health concerns with your doctor. This blog draws on my personal experience and research and the information contained should not substitute advice or directions from your doctor.

So, I was reading the other day that parents with JME have about a fifteen percent chance of having children with epilepsy, since JME is so often hereditary. So that got me thinking about epilepsy and pregnancy/having children, in general.

First, let's talk about your AEDs. If your doctor feels like it's an acceptable risk for you to stay on your AED (anti-epileptic drug), which he usually will, he may raise your dose, because of the increase in blood volume during pregnancy, rather than lower it. He may also raise your dose if you are on Lamictal or Keppra, because your body will use more of these two drugs.

On the other hand, if you're taking drugs such as carbamazepine, phenobarbital, phenytoin, primidone or valproate, he may lower your dose, to decrease potential harm to the fetus. These medicines are known to cause congenital birth defects such as spina bifida, cleft lip/palate, and certain heart defects, which could severely lower your baby's quality of life.

Polytherapy (taking more than one drug to control seizures) is NOT recommended during pregnancy, so if you are already taking more than one AED, you may want to see your neurologist immediately if you become pregnant.

More than likely, if you are a woman of childbearing age, you are already on a folic acid supplement. There is evidence that some AED's deplete folic acid levels in your body and that this is the cause of neural tube defects associated with AED's. I was not told why I was on it, which is why I'm saying this, but DO NOT STOP TAKING YOUR FOLIC ACID IF YOU BECOME PREGNANT!!! That's one of the biggest reasons you're on it, along with heart health. If you are not already on it, the folic acid present in a prenatal vitamin may not be enough, and you should talk to your neurologist and a high risk OBGYN to determine if it is necessary to begin supplementation.

Now, let's talk about your seizures. Absence seizures, simple partial seizures, and complex partial seizures during pregnancy typically are not dangerous to a fetus unless you injure yourself, which is rare. Tonic clonics on the other hand, can be very dangerous because of the risk of injury to the abdomen, and the interruption of your breathing. When your baby's developing body is deprived of oxygen during a convulsive seizure, his heart rate can slow for up to thirty minutes after your seizure is over. Repetitive or prolonged convulsive seizures during pregnancy can seriously damage your baby's brain and other organs. Convulsive seizures are most damaging to the baby in the third trimester, when his brain will need more oxygen.

I have some statistics for you:

• Only 20% of women have an increase in seizure frequency during pregnancy
• You have a 90% or better chance of having a healthy baby; this number is even higher if you plan the pregnancy with your doctor and a high risk OBGYN
• 1-2% of babies born to the general population will have a major birth malformation
• 4-9% of babies born to a mother on AED therapy will have a major birth malformation

Now labor and delivery. You have about a 2-4 % chance of having a tonic clonic seizure during labor triggered by the stress and pain of labor. Contrary to popular myth, you CAN have an epidural. More than likely your neurologist will recommend you deliver at a hospital, where emergency AED's such as Diastat can be administered in case of a seizure, and you have access to emergency care in case there are complications. Common complications epileptic women face during pregnancy are preeclampsia, gestational hypertension, bleeding in pregnancy and excessive bleeding postpartum. So if you are considering an at home birth with a midwife, please discuss the pros and cons with your doctor and make sure it is a safe option for you.

Most doctors will recommend you breastfeed your baby, as more of your AED reached the baby during pregnancy than is present in breast milk. Ask your neurologist and OBGYN if you have any concerns.

Now lastly, I want to give you some good tips for caring for your baby if your seizures are not completely controlled:

• Dress and change your baby's diaper on the floor
• Sponge bathe your baby on the floor if no one is around to assist you with bathing
• Carry your baby in a padded sling
• Breastfeed your baby on the floor if possible to minimize falls, or purchase a breast pump and bottle feed on the floor or in a bounce seat.
• Make sure you have a bumbo seat for your baby and feed him/her on the floor once he is eating solid food (a bumbo seat is very sturdy and low to the ground and will not tip if you knock into it during a seizure)

http://www.healthcommunities.com/epilepsy-seizures/epilepsy-and-pregnancy-overview.shtml

http://www.epilepsysociety.org.uk/AboutEpilepsy/Epilepsyandyou/Pregnancyandparenting-1

http://www.ncbi.nlm.nih.gov/pubmed/22327733

http://www.webmd.com/epilepsy/guide/parenting-concerns-women-epilepsy