Will Maternal Epilepsy or the Required Seizure Medications Cause Harm to a Growing Fetus?
Being pregnant is a time of great anticipation, but it is also a time that is fraught with a lot of anxiety. If you are an epileptic, pregnancy can be a precarious time. Epilepsy and seizure disorders are the most common conditions affecting women during their reproductive ages. In the U.S., according to estimations, as many as one million women with epilepsy give birth yearly. That amounts to as many as 24,000 babies delivered by women who have the condition. Often, there are no complications associated with epilepsy or epilepsy medications and the health of a fetus. The key is proper prevention and minimizing the risks associated.
What Are the Risks of Having Epilepsy During Pregnancy?
The severity of symptoms for pregnant women with epilepsy typically does not increase during their pregnancy. For many, in fact, they experience seizures at a lesser rate.
- Only between 15-30 percent of women experience an increase in the frequency of seizures. Most often, they experience them in the first or third trimester of pregnancy.
- The type of seizures that a woman usually experiences usually has no bearing on the frequency and is not predictive of what will happen once she becomes pregnant. Risk factors such as how long she has been epileptic, or even the frequency of seizures during any previous pregnancies, have no correlation to a current pregnancy.
- There are specific triggers which are suspect to trigger epileptic seizures. These include hormonal changes, decreasing blood levels of anti-epileptic medications, stress, and sodium and water retention.
- There is some evidence to suggest that not taking the necessary medications in combination with sleep deprivation are the most significant risk among pregnant women with epilepsy. It is also imperative that they frequently communicate with their neurologist during their pregnancy.
- If a woman is seizure-free for as many as nine months before getting pregnant, the chances of her having a seizure during her pregnancy go down significantly.
What Risks Are Associated with Seizures and Pregnancy?
Having epileptic seizures is not only harmful to the mother, but in some instances, they may adversely affect the growing fetus. The extent of risk to both is reliant upon the type of seizures that the mother has.
- Generalized seizures carry a much greater risk than partial seizures.
- The biggest risk with partial seizures is that they can secondarily generalize. Tonic-clonic and other generalized seizures pose the greatest risk to both the fetus and mother.
- The major risks involved during seizures are falls, burns, a risk of premature labor, a lower fetal heart rate, decreasing oxygen flow, and miscarriage.
- Not taking seizure medications appear to pose a greater risk than the risk of having a seizure. Maintaining control is the best prevention there is for a healthy mother and baby.
What Are the Risks of Taking Epilepsy Medications While Pregnant?
- The biggest risk associated with epilepsy medications are birth defects or congenital malformations. The risks in the general population are as low as 2-3% and cannot be prevented or predicted. For those who take seizure medication, the risks are double, but that still only amounts to 4-6%.
- A combination of medications and a higher dosage increase the risk of complications to a growing baby.
- If there is a family history of congenital malformations, or if there have been previous pregnancies resulting in malformations, then the risk is greatly higher due to genetics.
- The most common congenital malformations found linked to the use of epilepsy medications is a cleft palate or cleft lip. The good news is there are surgeries for both conditions. Other more severe abnormalities are urogenital or cardiac defects. The research correlating epilepsy medications and developmental delays are inconclusive.
Which Anti-Epileptic Drugs Carry the Greatest Risk?
There is little evidence about the risks associated with new epileptic medications hitting the market versus traditional medications. Due to the ethical constraints with experimentation, medical experts do not know much about what AED medications do in general.
While most epileptic drugs are safe, there are some that come with increased risks:
Valproic or Valproate Acid (VPA)
- When used at the beginning of pregnancy, studies indicate that there is as much as a 1-2% increased risk of neural tube defects and a 10% risk of other major congenital malformations.
- The NEAD study found that those babies born to women who took VPA had a lower IQ than the general population and a higher risk of developing autism.
- The studies were all relative to dose response.
What Can a Woman with Epilepsy Do to Lessen Risks to Her Baby?
- Like any pregnancy, a woman should increase her intake of folic acid, both before becoming pregnant and in the first trimester to lower the risk of neural tube defects.
- When possible, it is especially important for epileptic women to up their intake of folate before becoming pregnant.
- A dosage of over 4 milligrams of folate is recommended for women of childbearing age as a preventative measure.
- Zinc and selenium may help to lessen risks to the fetus.
- Vitamin K can benefit women who take enzyme-inducing AEDs in the later trimesters of pregnancy to prevent any additional bleeding and the complications that excessive bleeding can cause.
Other Risk Prevention Strategies that May Be Helpful:
- Women who have epilepsy should make sure that they have the proper knowledge to make the best decisions for themselves.
- If a woman is on a high dosage of medications to manage epileptic seizures or an abundance of them, it is important for her to meet with her neurologist to discuss the potential of either lowering the medication or decreasing the number of them. Doctors should weigh the risks on a case-to-case basis.
- Monitoring the level of drugs that a woman has in her system is very important to ensure that they are not toxic both during pregnancy and after delivery. Since there will be fluctuations during different times of her pregnancy, constant monitoring is critical for the safety of both mother and baby. Adjustments to medications should be made on a risk/reward basis.
- It is also important to monitor a baby who is born with serum-alpha-fetoprotein tests to check for abnormalities and to do a level two ultrasound to check for congenital malformations.
- Cesarean sections do not decrease the risk of this affliction.
- AEDs can be present in breast milk, but breastfeeding is still essential. Since the baby has been previously introduced to the drugs and there has been no adverse effect, the amount that they get through breast milk is substantially lower and should not pose any additional risks. The benefits of breastfeeding outweigh any potential risks.
- Caring for a baby when you have epilepsy comes with higher risks, especially while bathing or holding an infant.
- Make sure to check with a physician if you intend to get pregnant to discuss a good plan of action. Regular medication checks while pregnant are crucial to the health of both the mom and baby.
- Take the medications as recommended and try to get a healthy amount of sleep.
- Make sure that you are taking vitamins before becoming pregnant and then throughout your pregnancy to decrease any risks.
- Avoid triggers like caffeine, cigarettes, and alcohol during pregnancy.
- The good news is that if you get the proper information, work closely with your physician, and have a good plan of action, the chances are good that epilepsy seizures and epilepsy medications should have no adverse affects on either you or your baby.