Epilepsy during Pregnancy
Women with epilepsy who are thinking of having children need to know about the whole picture:
- the genetics of epilepsy;
- the effects of pregnancy on the medical management of seizures;
- the effects of seizures and medication on the developing fetus; and
- the planned management of seizures during labour and after birth.
Finding a health care practitioner who can answer questions about these issues and who gives you all the information you feel you need can help to reduce your stress during pregnancy.
Good communications with your health practitioners and pre-planning are key issues.
The importance of planning before you become pregnant cannot be overstated. Certain vitamins for the healthy development of your child – such as folic acid – can be depleted when you take anticonvulsants. Folic acid is most important in the first few months of pregnancy. In addition, some antiepileptic drugs have less potential to harm your child than do others. Choosing the best medication for your type of seizures and for your child's development is a decision that is best made before you get pregnant.
As your pregnancy progresses, the dose of your antiepileptic drugs will need to be adjusted to meet the changes in your metabolism. The first adjustments may occur towards the end of the third month. It is very important not to stop taking your drugs during pregnancy in the mistaken notion that they will harm your baby. Abrupt withdrawal of drugs can cause a life-threatening condition called status epilepticus and can risk your pregnancy. If you have concerns about the side effects of your medications, talk to your doctor about them before you get pregnant, if possible, or as early on in your pregnancy as you can. Your neurologist may want to check your drug levels monthly as your pregnancy progresses.
It is rare for women to begin to have seizures when pregnant and most women with epilepsy report no change or a decline in seizures during pregnancy. However, 1 in 3 women with epilepsy have increasing seizure frequency during pregnancy. For many women, improving levels of antiepileptic drugs in the blood and ensuring adequate sleep can reduce the number of seizures.
Many women worry that they will have seizures while giving birth. Discussing risks with your health practitioners may help to alleviate your fears. The onset of labour is unlikely to precipitate a seizure. However, you may be more susceptible to having seizures after giving birth. Lack of sleep or missed drugs during labour can be contributing factors. In addition, as your metabolism changes after birth, your drug dosage may need to be adjusted. Good questions to ask beforehand include:
What is my likelihood of having a seizure during labour?
What are the risks to the baby?
How would a seizure during labour be treated? and
How do we plan to manage my seizures after birth?
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