Epilepsy and pregnancy: how to cope?

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Doctors recommend that women with epilepsy continue taking medication during pregnancy to control seizures, despite the risk of birth defects. Increasing folic acid intake is also encouraged, and joint meetings between obstetricians and neurologists are needed to coordinate treatment. Babies born to women with epilepsy may have low birth weight and a tendency to have seizures. Breastfeeding is generally encouraged, with some precautions.

Women who have epilepsy during pregnancy can continue to take medications to control seizures, even though they could lead to birth defects, most doctors say. Antiepileptic drugs can contribute to birth defects such as deformed skeletons and cleft palates in about 8 percent of women. Seizures, however, are a greater danger, as they can cause the placenta to detach from the uterus or trigger a premature birth. Oxygen deprivation for the baby can also occur if the mother has a seizure, which is why continued therapy is recommended. Many doctors are able to reduce medication dosages for some epilepsy patients during pregnancy to reduce the risk of birth deformities.

Increasing folic acid intake three months before conception is encouraged for women with epilepsy. While all pregnant women require folic acid, women with epilepsy generally need more to prevent spinal cord, neural tube, and brain defects, which seizure medications can cause in developing babies. Frequent ultrasounds can monitor whether abnormalities are forming in the children of women with epilepsy. Medical statistics suggest that approximately 90% of women with epilepsy are able to bear healthy babies.

Joint meetings between a woman’s obstetrician and neurologist are usually needed to coordinate treatment for epilepsy during pregnancy. These medical teams can often decide to reduce several drugs to a single selection. Blood levels and blood pressure are regularly monitored by your healthcare team to prevent anemia, vaginal bleeding and preeclampsia, all three of which can be present during pregnancy for women with epilepsy. Stress levels are also monitored, as they can trigger seizures.

Those who suffer from epilepsy during pregnancy should be prepared for more severe morning sickness, doctors say. Babies born with low birth weight and, in some cases, stillborn babies are a possibility for women with epilepsy during pregnancy. After birth, internal bleeding may occur in infants born to women with epilepsy; doctors typically recommend vitamin K supplements to combat this risk. Babies of mothers with epilepsy may also develop a tendency to have seizures which can lead to impaired development and physical injury.

Seizures during labor are rare. However, if a seizure is triggered during delivery, doctors may give intravenous medication to stop the seizure. These medications should not interfere with pain relievers given to facilitate delivery. For extreme or prolonged seizures, doctors may opt for cesarean delivery over vaginal delivery.

Many women wish to breastfeed their newborns after triumphing over epilepsy during pregnancy. Although trace amounts of some drugs enter the breast milk supply of nursing women with epilepsy, many doctors encourage breastfeeding, particularly if mothers can take drugs after feeding or during hours when the baby is sleeping. Drugs like phenobarbital can make children drowsy.

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