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Epilepsy and Pregnancy

Dr. Arun K. Dhanuka

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Highlights: Plan the pregnancy. Discuss with the patient beforehand (Start before pregnancy and continue throughout) Do not stop/alter doses of anti-epileptic drugs unless absolutely essential. Remember, a seizure is more dangerous than the side effects of anti-epileptic drugs. There is only marginal increase in the risk of foetal malformation. Advise to avoid all addictions and bad habits (smoking, alcohol, drugs) Continue breastfeeding if possible. Consider vitamin K. Prenatal exposure of anti-epileptic drugs do not cause significant cognitive impairment.

Women of child bearing age who have epilepsy have many questions about how epilepsy and the anti-epileptic medications they are taking will affect them and their unborn child during pregnancy. Epilepsy does impose special risks for pregnancy and one should be aware of these risks. The risks, however, can usually be managed in such a way as to keep the mother healthy and give her a very good chance of delivering a normal healthy baby.

What are the special risks to pregnancy associated with epilepsy?

Risks to the mother: Pregnancy can increase the frequency of seizures in the mother. This is not a high risk. About half of pregnant women have no change in the number of seizures during pregnancy. For some, the frequency decreases. But for about one fourth of pregnant women, seizure frequency increases. Many women experience this increase in seizure frequency because they reduce the amount of antiepileptic medication they take.

Risks to the fetus: The mother’s seizures represent the single largest risk to the unborn because the fetus can be seriously deprived of oxygen during the mother’s seizure. The fetus may, of course, be injured if the mother falls, is involved in an auto accident, or seriously burns herself during a seizure. Thus the goal during pregnancy should be to prevent all seizures. Children born to women with epilepsy are, on average, smaller in size and weight when compared to children born to women who do not have epilepsy. The reasons for this discrepancy are not clear. The difference does not appear to be related to antiepileptic medications because it remains whether the mother took medication or not. The difference in birth weight is not large enough to worry about. There is a somewhat greater risk of fetal malformation when the mother has epilepsy. Some of these malformations include a small head, slowed growth, and impaired intellect. Certain other abnormalities, such as cleft lip, cleft palate, heart abnormalities, and spina bifida are seen more frequently in children born to mothers on antiepileptic medications. Less serious fetal abnormalities include crossed eyes, drooping eyelids, broad fingers, decreased muscle tone, hernias, and clubfeet. However the risk of fetal malformations associated with epilepsy is very small. The fetal risk of pregnancy in normal women is about 3%. In women with epilepsy, the risk is 5 % i.e. just 2% high. Other common diseases represent a much higher risk for fetal deformity than epilepsy e.g. diabetic women have 8% risk much higher compared to epilepsy. There is considerable controversy about the risk to the fetus of antiepileptic drugs. In general the risk from the drugs is very small. A seizure during pregnancy is much more dangerous to the development of the fetus than the dangers associated with anti-epileptic medications. Thus if the risk for recurrent seizures is high then medication must be used. The choice of drug clearly depends on the type of seizures (Classification of epilepsy). Prepare patient before she becomes pregnant.

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