Editorial ↵

Epilepsy In Pregnancy

Epilepsy (convulsions, fits or seizures) in pregnancy complicates 1% of pregnancies. There are many myths and concerns regarding epilepsy in pregnancy, so here are some queries answered…

• How should I plan my pregnancy if I am an epileptic?
If you are epileptic and are planning a pregnancy, it is important that you start taking high dose folic acid supplementation (5mg per day) three months pre-conception. Also, you must consult a Maternal and Fetal Medicine specialist who can counsel and guide you regarding the various aspects of this condition and its effects on pregnancy. Do NOT stop taking anticonvulsant medications without taking proper advice as this is dangerous for you and also for your unborn baby.

• Is maternal epilepsy dangerous to the unborn baby?
Maternal epilepsy is associated with a twofold increase in the incidence of congenital abnormalities (birth defects). Congenital anomalies most commonly associated with these medications and epilepsy include facial abnormalities (such as cleft palate and cleft lip) and cardiac abnormalities (such as ventricular septal defects and atrial septal defects). These anomalies can be detected on a detailed fetal anomaly scan, especially a 3D-4D ultrasound.

• Is anti-convulsant therapy or medication used to control epilepsy harmful to the unborn baby? Can I stop all my medications to avoid harm to the baby?
Treatment of the epilepsy is by anticonvulsant therapy. Anticonvulsant therapy may contribute to the incidence of congenial abnormalities in the children of epileptics, but some increased risk is present regardless of the medications used as treatment for the epilepsy. However, anticonvulsant therapy in pregnancy is needed in order to prevent uncontrolled generalized seizures. Uncontrolled generalized seizures can be dangerous to both the mother and her unborn baby, hence do not stop medications without consulting your doctor.
Phenytoin, carbamazepine and lamotrigine have been used successfully in pregnancy. Phenobarbital and Valproic acid may be associated with a higher rate of congenital anomalies.

• Will the seizure frequency increase during pregnancy?
Approximately 20% of epileptic women may experience an increased seizure frequency during pregnancy. This could be due to low anticonvulsant levels, poor compliance with anticonvulsant therapy, nausea and vomiting and sleep deprivation. Total blood levels of anticonvulsants tend to go down in pregnancy due to increased hepatic and renal clearance and an increased volume of distribution. Serum blood levels should be checked monthly in pregnant women and anticonvulsant dose adjusted accordingly. Some clinicians prefer to follow their patients clinically and monitor levels and adjust dosing only if seizures (fits or convulsions) occur. After delivery, mothers with seizure disorders may need a reduced dose of the anticonvulsant medication.

• Are there any special precautions during labour / delivery?
Vitamin K administration in the last month of pregnancy decreases the risk of hemorrhagic disease of the newborn and postpartum hemorrhage in the mother. A normal delivery can be attempted if conditions are favourable for the same.

• Are there any special precautions for the baby care? Can I breastfeed my baby?
Mothers with seizure disorders should be given some practical advice about safely caring for their newborns. Care should be taken to avoid situations of risk, especially if seizure control is suboptimal.
Breast feeding must be encouraged and is completely SAFE even if the mother is taking anti-convulsant medications.