Epilepsy in pregnancy: Balancing Risks and Benefits

Epilepsy is a neurological disorder characterized by seizures that are caused by abnormal electrical activity in the brain. 

If a woman with epilepsy becomes pregnant, there are certain considerations and risks that should be taken into account.

Firstly, it is important to continue taking antiepileptic medications as prescribed, as stopping or changing medications can increase the risk of seizures, which can be harmful to both the mother and the developing fetus. 

However, some antiepileptic medications may increase the risk of birth defects or other complications, so it is important to work closely with a healthcare provider to determine the safest treatment plan.

Women with epilepsy may also be at higher risk for certain complications during pregnancy, such as preeclampsia (high blood pressure during pregnancy) and preterm labor. 

Close monitoring by a healthcare provider is important to manage these risks and ensure the health of both the mother and the baby.

Planning on getting pregnant

If you are planning on getting pregnant, there are several steps you can take to prepare for a healthy pregnancy and increase your chances of having a healthy baby.

Schedule a preconception checkup: This is an important first step to ensure that you are in good health and to identify any potential health concerns that may affect your pregnancy. 

Your healthcare provider can also provide guidance on a healthy diet, prenatal vitamins, and other lifestyle changes that may improve your chances of conceiving and having a healthy pregnancy.

Start taking prenatal vitamins: Prenatal vitamins are specially formulated to provide the nutrients that are important for fetal development, such as folic acid, iron, and calcium. 

Taking these vitamins before and during pregnancy can help reduce the risk of birth defects and other complications.

Maintain a healthy lifestyle: Eating a balanced diet, exercising regularly, getting enough sleep, and avoiding alcohol, tobacco, and other harmful substances can all help improve your overall health and increase your chances of having a healthy pregnancy.

Manage any chronic health conditions: If you have a chronic health condition, such as diabetes or high blood pressure, it is important to work closely with your healthcare provider to manage it before and during pregnancy.

Consider genetic counseling: If you have a family history of certain genetic disorders, or if you are concerned about your risk of passing on a genetic condition to your baby, genetic counseling can help you understand your risks and options.

Effect of pregnancy on your epilepsy

Pregnancy can have an effect on epilepsy in some women. Some women with epilepsy experience changes in their seizure patterns during pregnancy, while others may not experience any changes at all. 

The exact effects of pregnancy on epilepsy can vary depending on a number of factors, including the type and severity of epilepsy, the medications being taken, and the individual woman’s health.

In some cases, pregnancy may cause an increase in seizures, especially during the first and third trimesters. 

This may be due to changes in hormone levels or other factors that affect brain activity. 

However, in other cases, pregnancy may actually improve seizure control. 

This may be due to hormonal changes or other factors that reduce the frequency or severity of seizures.

It is important for women with epilepsy who are pregnant or planning to become pregnant to work closely with their healthcare provider to manage their condition. 

This may involve adjusting medications or monitoring for changes in seizure patterns. 

Some anti-epileptic medications can be harmful to a developing fetus, so it is important to work with a healthcare provider to develop a treatment plan that is both effective for managing seizures and safe for the baby.

Overall, with proper management and monitoring, women with epilepsy can have healthy pregnancies and deliver healthy babies. 

Risks from epilepsy medicines

Anti-epileptic medications can be effective in managing seizures, but they can also carry some risks, particularly during pregnancy.

One potential risk is that some anti-epileptic medications can increase the risk of birth defects. 

This risk varies depending on the medication, the dosage, and the timing of exposure during pregnancy. 

For example, valproate is a medication that has been shown to increase the risk of birth defects and developmental delays when taken during pregnancy.

Another potential risk is that some anti-epileptic medications can affect fetal growth or development. 

Again, the risk varies depending on the medication and the dosage. 

For example, phenobarbital has been shown to increase the risk of low birth weight and developmental delays.

In addition to these risks, anti-epileptic medications can also have side effects that can affect the mother’s health and quality of life. For example, some medications can cause fatigue, dizziness, or nausea.

It is important for women with epilepsy who are pregnant or planning to become pregnant to work closely with their healthcare provider to manage their condition. 

This may involve adjusting medications or monitoring for changes in seizure patterns. 

In some cases, it may be possible to switch to a medication that carries a lower risk of birth defects or other complications.

Overall, with careful management and monitoring, women with epilepsy can have healthy pregnancies and deliver healthy babies.

Sodium valproate and valproic acid

Sodium valproate and valproic acid are both medications that are commonly used to treat epilepsy and other neurological disorders. 

They belong to a class of drugs known as anti-epileptic medications, or AEDs.

Both medications work by increasing the levels of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, which helps to calm overexcited nerve cells and prevent seizures.

However, sodium valproate and valproic acid can also carry some risks, particularly during pregnancy. 

These medications have been shown to increase the risk of birth defects and developmental delays when taken during pregnancy, particularly when taken at higher doses or for longer periods of time. 

These risks are greater with sodium valproate than with valproic acid.

Due to these risks, healthcare providers may recommend alternative medications for women who are pregnant or planning to become pregnant. 

If a woman with epilepsy is already taking sodium valproate or valproic acid and becomes pregnant, her healthcare provider may recommend reducing the dose or switching to a different medication, depending on the severity of her seizures and other factors.

Care during pregnancy

During pregnancy, it is important for women to receive regular prenatal care from a healthcare provider. 

This typically involves regular check-ups, monitoring of fetal growth and development, and screening for any potential complications.

Women with epilepsy who are pregnant or planning to become pregnant should work closely with their healthcare provider to manage their condition. 

This may involve adjusting medications or monitoring for changes in seizure patterns. 

Some anti-epileptic medications can be harmful to a developing fetus, so it is important to work with a healthcare provider to develop a treatment plan that is both effective for managing seizures and safe for the baby.

In addition to medical care, women can take steps to support a healthy pregnancy by following a balanced and nutritious diet, getting regular exercise, and avoiding alcohol, tobacco, and other harmful substances. It is also important to manage stress and get enough rest.

Overall, with proper prenatal care and management of any underlying medical conditions, women can have healthy pregnancies and deliver healthy babies. 

It is important to work closely with a healthcare provider and follow their recommendations to ensure the best possible outcomes.

Labour, birth and beyond

Labour, birth, and the postpartum period are important stages in the process of pregnancy and childbirth. 

Here are some key things to keep in mind during this time:

Labour:

Labour is the process of giving birth and typically begins with contractions or the breaking of the amniotic sac.

During labour, it is important to stay hydrated, rest when possible, and communicate with your healthcare provider about any concerns or questions you may have.

Pain management options may be available, such as epidural anesthesia, which can help manage the pain of contractions.

Birth:

The birth of a baby can be a joyful and intense experience. It is important to communicate with your healthcare provider and birth team to ensure that you feel supported and comfortable.

The method of delivery may vary depending on individual circumstances. 

Vaginal delivery is the most common method, but a caesarean section may be necessary in certain situations.

After the birth, the healthcare team will monitor the mother and baby for any potential complications.

Postpartum:

The postpartum period is the time after giving birth when the body undergoes many physical and emotional changes.

It is important to get enough rest, stay hydrated, and eat a healthy diet to support healing and recovery.

Breastfeeding is a common way to feed a newborn baby and provides many benefits for both the baby and mother.

Postpartum depression and anxiety are common and can be managed with support and treatment.

Overall, labour, birth, and the postpartum period can be a challenging but rewarding time for new mothers. 

Folic acid

Folic acid is a type of B vitamin that is important for the healthy development of a fetus. It is essential for the formation of the neural tube, which later becomes the brain and spinal cord.

Taking folic acid before and during pregnancy can reduce the risk of neural tube defects, which can lead to serious disabilities or even death. 

Neural tube defects occur in the first few weeks of pregnancy, often before a woman even knows she is pregnant, so it is important to take folic acid regularly if you are planning to become pregnant.

The recommended dose of folic acid for women who are planning to become pregnant is 400 micrograms (mcg) per day. 

During pregnancy, the recommended dose increases to 600 to 800 mcg per day. 

Women who have already had a pregnancy affected by a neural tube defect, or who have certain medical conditions or take certain medications, may require higher doses of folic acid.

Conclusion

Pregnancy is an exciting and challenging time for women, and it is important to take steps to ensure a healthy pregnancy and a healthy baby. 

This may involve working closely with healthcare providers, managing any underlying medical conditions, and making lifestyle changes to support overall health and well-being.

Overall, with proper care and support, women can have healthy pregnancies and deliver healthy babies. 

It is important to stay informed, communicate openly with healthcare providers, and take steps to prioritize physical and emotional health throughout the pregnancy and childbirth process.