If I become pregnant, what are my chances of having a healthy baby?
Your chances of having a normal, healthy child are excellent -- greater than 90%. However, there are some increased risks for women with epilepsy that you should consider before getting pregnant, if possible. Both your neurologist and your gynecologist/obstetrician need to be involved in reviewing your antiepileptic drug (AED) and any potential medication changes prior to the beginning of a pregnancy.
Do women with epilepsy have problems getting pregnant?
Overall, women with epilepsy have fewer children than other women. This may be partly personal choice, but research has indicated that women with epilepsy have a higher rate of menstrual cycle irregularities and other gynecological problems that may interfere with fertility. Again, it is important that you talk with your gynecologist/obstetrician and your neurologist to sort through these issues.
The more we learn about pregnancy and epilepsy, the greater our understanding of the risks of AEDs to infants. If you are a woman with epilepsy and you become pregnant, please register with the AED Pregnancy Registry, housed at Massachusetts General Hospital, Harvard Medical School. The Registry will confidentially track your pregnancy and its outcome. As more women register and report the outcome of their pregnancy, the researches will be able to identify the safest AEDs for seizures during pregnancy and also determine how safe the newer AEDs are.
What do I have to do to get ready for a pregnancy?
All women should be in good general health and pay attention to their nutrition before and during pregnancy. If finances are a problem, you may qualify for funded nutritional programs such as Women, Infants and Children Supplemental Food Program (WIC). Information about this program can be obtained from your physician's office or from your local health department.
A regular schedule with adequate exercise and appropriate rest will keep you physically fit and may help you manage stress. It is important to take vitamins with folic acid prior to and throughout pregnancy, to reduce the risk of certain kinds of birth defects. Since many of these problems occur very early in pregnancy (sometimes before you know you are pregnant), it is wise to start taking folic acid before becoming pregnant. Check with your physician about the exact dosage.
You may want to ask your physician for a referral to a genetics specialist who can help you assess the risks to your baby from your epilepsy, your seizure medication, and other inherited traits that may be present in your family.
Will my epilepsy cause problems during my pregnancy?
Most women who have epilepsy do not have any unusual problems with their pregnancy.
Studies do show, however, that women with epilepsy have an increased risk of vaginal bleeding both during and after pregnancy. Early and continued prenatal care by your obstetrician is very important. Consistent visits will immediately alert you and your doctor to any problems during your pregnancy and will allow for prompt treatment.
It is very important to avoid tobacco, alcohol, caffeine, and drugs such as marijuana and cocaine. Other dangers may come from environmental chemicals like pesticides, paints and oven cleaners. All of these toxins have been associated with pregnancy complications and poor pregnancy outcomes. By avoiding them, you can eliminate the risk of compounding any negative effects of your anticonvulsant medication.
How can pregnancy affect my seizures?
Most women will see no change in their seizures. One quarter to one third of women with epilepsy who become pregnant will have increased seizures during their pregnancy despite continued use of antiepileptic medication. During pregnancy, concentrations of seizure medication in your bloodstream may change or decrease, putting you at greater risk for seizures. Your physician may need to check blood levels of your medication more often, and may need to adjust your dose. The first two months after delivery are another time when your hormones and your body chemistry may change, affecting levels of your seizure medication. Check with your doctor or nurse about extra lab work that may be necessary.
If I have seizures when I'm pregnant, will they harm my baby?
Although many mothers who have seizures also have perfectly normal babies, seizures during pregnancy can harm the baby.
Generalized tonic clonic (grand mal) seizures can cause miscarriages, although this is a very rare occurrence. Generalized tonic clonic seizures during the last month of pregnancy can cause injury to the baby. If they occur during labor, they reduce fetal heart rate, which can indicate that the baby is in distress. The reason for the heart rate drop is not clearly understood. It is most likely due to a decrease in oxygen because the mother is not breathing adequately, or to a decrease in blood supply during the seizure, or both.
Generalized tonic clonic seizures during pregnancy have not been associated with birth defects. However, one study reported an increased risk for any type of negative effect if the mother had a seizure during pregnancy.
For all these reasons, it is important to reduce the number of seizures you have during pregnancy. Work closely with your doctor, be sure to take your medication as prescribed and avoid those things which may cause you to have a seizure. Notify your neurologist whenever you have a seizure.
However, don't panic if you have a seizure while you're pregnant. Remember, there are many normal, healthy babies born to women who had seizures during their pregnancy.
Is it true that medication taken for seizures may affect my child?
Yes, there may be some increased risk to children of women with epilepsy who are taking seizure medications. In the general population there is a 2-3% chance that a child will have a birth defect (also called a congenital malformation). In women with epilepsy, this risk is increased to 4-8%. In general, there seems to be higher risk if a woman is taking more than one seizure medication, particularly at high doses.
But there are other risks, to both mother and developing child, from uncontrolled seizures. Most women with epilepsy should continue their seizure medication, and whenever possible, take a single AED at the lowest dose that provides seizure control. It is important to work with your health care team to make the best decisions about medications during pregnancy. Remember, you should never stop taking your AED or change the dose without the advice and the supervision of your doctor. It is important to remember that even with the increased rate of certain kinds of birth defects, women with epilepsy who become pregnant have a better than 90% chance of having a healthy baby.
What kind of birth defects might my baby have?
Major birth defects are found more often in the babies of women with epilepsy than in other babies. Examples are cleft lip or palate (portions of the mouth do not grow together properly), heart abnormalities, and neurological problems such as spina bifida (deformities of the spinal cord). Surgery to correct the malformation may be necessary and even then it may not be possible to "fix" the problem completely.
Other problems that may occur are considered minor birth defects and primarily affect the baby's appearance. These can involve facial features, such as wide-set eyes or a short upper lip, or slight differences in the shape of the fingers and nails. These minor abnormalities do not cause any serious problems.
Some research studies have found that women with epilepsy more often have children with small head size, developmental delays, and possibly mental retardation than has been identified in the general population. Other studies don't support this finding. We don't know whether these abnormalities are caused by the mother's seizure disorder, the AEDs she is taking, or other factors unrelated to her epilepsy.
Are some antiepileptic medications more dangerous for the baby than others?
All commonly used seizure medications have been associated with birth defects although some of the newer AEDs have not been used in large enough numbers of women to know their effect on the developing child. Valproic acid (Depakene or Depakote) and carbamazepine (Tegretol, Carbatrol) have been linked to spina bifida. Using the information from current research, the risk with valproic acid seems greater (1-2%) than that with carbamazepine (0.5%). It is important to recognize that most infants of mothers who take these seizure medications do not develop spina bifida or any other birth defect. Taking folic acid before and throughout pregnancy may decrease this risk.
Should I stop my antiepileptic medication before I get pregnant?
This is a complicated decision. Pregnancy without antiepileptic medication might lessen some of the possible risks to the baby. If a woman has been seizure-free for many years, it may be possible for her and the physician to slowly discontinue medication before she attempts to become pregnant. Remember, you should never stop your seizure medication without the advice and supervision of your doctor.
However, the danger of seizures to both the mother and the child is a serious one. Seizures can result in falls or in lack of oxygen for the baby. They can increase the risk of miscarriage or stillbirths. For most women with epilepsy, staying on medication poses less risk to their own health and the health of their babies than discontinuing medication. In most cases, a single medication at the lowest possible dose that provides seizure control is the best option.
Am I more likely to have a seizure during delivery? Is this dangerous?
Seizures seldom occur during delivery. A seizure during labor is usually not dangerous, but can make your delivery more difficult. During labor, a woman's breathing rate increases. Rapid breathing (hyperventilation), coupled with the pain and anxiety of giving birth, may occasionally lead to a seizure. If a seizure should occur during delivery, your obstetrician will be prepared to deal with the situation. Intravenous medication may be administered to stop the seizure. If the seizure is prolonged, your obstetrician may decide to perform a cesarean section to protect the baby.
Taking your medication as prescribed, before and throughout labor, is important in order to maintain your antiepileptic drug levels. Sometimes seizures during labor may not be related to epilepsy but to the pregnancy itself. This condition is called eclampsia, and symptoms leading up to the seizures are called pre-eclampsia. Your obstetrician will monitor you for these symptoms.
Will I need to have a cesarean section because I have epilepsy?
Simply having epilepsy is not a reason for having a cesarean section. Most mothers with epilepsy are able to deliver their babies normally. A cesarean section will be performed by your obstetrician only if it is necessary for your baby's safety.
Although some studies have shown that women with epilepsy are more likely to have some type of intervention during delivery, including cesarean sections, the cause for this has not been determined.
Are there other problems to consider besides my epilepsy?
Yes, women with epilepsy are more likely to have morning sickness and vaginal bleeding during pregnancy. There is an increased risk for early labor and delivery. Sometimes labor does not progress normally and more women with epilepsy need to have cesarean sections to deliver their babies than other women.
There is a small risk that your baby will develop a bleeding problem in the first 24 hours after birth. Women with epilepsy are often given oral vitamin K supplements during the last month of pregnancy to lessen the chances of this happening to their babies.
Is there anything I can do that will help reduce all of the risks to my baby?
The best thing you can do for your baby is to take good care of yourself. This includes consulting with your doctor early, taking your medication as well as your prenatal vitamins, and getting proper amounts of food, sleep and exercise. In order to minimize the risks to you and your baby, you need to do everything possible to maximize the chances of a normal pregnancy and delivery. Prenatal care is most important in helping you achieve this goal.
Look after yourself. Pre-pregnancy and follow-up appointments with your neurologist will help to monitor your medication as your pregnancy progresses. Good nutrition will ensure that you gain enough weight, which is vitally important to your baby's health (25 to 30 pounds is usually recommended). Smoking is a very high risk to all babies, and can have serious consequences to their health and development. Alcohol and caffeine also carry risks.
Reduce stress. While you are pregnant, try to reduce the stress in your life. Get plenty of rest and sleep, and engage in moderate exercise such as walking every day. If your stress level remains high, it may be helpful to ask your doctor or nurse about relaxation techniques.
Take prescribed medication. Always remember to take your medication as prescribed, and be sure to report seizures to your doctor so measures can be taken to reduce them. You should also take prenatal vitamins that contain folic acid. The National Center for Disease Control and Prevention in Atlanta recommends that all women of childbearing age take at least 0.4 mg. of folic acid per day because it may play a part in reducing the risk of birth defects. To get the maximum benefits of folic acid, you should begin taking it before you become pregnant, and then continue it throughout your pregnancy. Keep in mind that much of your baby's development will take place during its first six weeks in the womb.
I don't think I could take care of a child with a disability. What can I do?
If you have concerns about your pregnancy, ask your physician for a referral to a specialist in genetic conditions. Genetic counseling may be helpful in assessing the possible risks. This expert can recommend tests, such as an ultrasound or an amniocentesis, which will identify some types of birth defects. If the results show an abnormality, your physician can counsel you about the options available to you. However, as in any pregnancy, there are many conditions we cannot identify ahead of time.