Seizures Disorders In Pregnancy

    A woman who has a seizure disorder (also called epilepsy) may need to take medication to prevent seizures.  Women with a seizure disorder who want to have a baby should work with their doctor to adjust their medication before and during pregnancy.  Today, most women with a seizure disorder who become pregnant have healthy babies.

 

 

 

SEIZURE DISORDERS AND WOMEN

     The nerve cells in the brain produce electrical impulses, which send messages throughout the body.  These messages control the body's movements and functions.  In a person with a seizure disorder, there is abnormal electrical activity in the brain.  This causes the seizure.  Hormones can have an effect on seizure disorders.  For women, this includes the sex hormones that control the reproductive system: estrogen and progesterone.  Changes in these levels of hormones can make seizures more or less likely.  Some women will have changes in seizure patters when hormone levels shift, such as during pregnancy. 

 

TREATMENT

     Medications to treat seizure disorders are call antiepilectic drugs (AEDs), or "antiseizure" drugs.  In most cases, AEDs will prevent seizures all or most of the time.  You may have to try more than one AED before you find the right one for you.  Pregnancy can change your pattern of seizures and how your body reacts to AEDs.  For this reason, women with seizure disorders should consult their ob-gyn and neurologist if they are pregnant or planning pregnancy.  They will need to receive special care before and during pregnancy.  Medications taken during pregnancy can affect a growing fetus.  Seizures also can harm the fetus as well as the mother.  If you are pregnant, it may be better to stay on the AEDs than to risk having a seizure during pregnancy.  If a women has not had a seizure in 2 or more years, she may be able to slowly stop taking her AED before she tries to become pregnant.  Working closely with her doctor, the amount of AED may be reduced over several months.  As many as half of women will need to go back on the AED after childbirth.  You will need to discuss this with your neurologist.  AEDs affect the way the body uses folic acid.  not having enough folic acid has been linked to problems during pregnancy and to certain birth defects.  For this reason, all women of childbearing age should take 0.4 mg of folic acid each day-even if they are not planning on pregnancy.  Taking folic acid before and during the first weeks of pregnancy may decrease the risk of these problems.

 

 

Folic Acid: The Vital Vitamin Women should have 0.4 milligrams a day of folic acid before pregnancy and during the first 3 months of pregnancy to reduce the risk of having a baby with a neural tube defect.  This is even more important for women with seizure disorders because of their increased risk,  Folic acid can be found in many food sources: Dark, leafy greens and vegetables (such as spinach, collard and turnip greens, Romaine lettuce, broccoli, and asparagus) Whole grain breads and cereals Citrus fruits and juices (such as strawberries, oranges, and orange juice) Organ meats (such as liver) Dried peas and beans (such as pinto, black, navy, and lima beans; chickpeas; and black eyed peas)

 

 

RISKS FOR THE MOTHER

     There is a chance that seizures will occur more often during pregnancy.  This happens to as many as one third of women, even though they are taking AED.  The amount of medication you take may change during your pregnancy.  This is because of hormone changes and changes in how the body processes AEDs during pregnancy.  Levels of AEDs should be watched to keep them constant.  If levels are too high, it can lead to side effects.  if levels are too low, it can lead to seizures.  You may have blood tests during pregnancy to check levels of the drug.  Women with seizure disorders are more likely to have other pregnancy problems.  This includes high blood pressure as a result of pregnancy.  Also, seizures can cause bad falls, resulting in injury. 

 

RISKS FOR THE BABY

     Most babies are born healthy.  In all women, the risk of having a baby with a birth defect is 2-3%.  For women with a seizure disorder, the risk is slightly higher 6-8%.  The risk may be related to the medication used, the disorder itself, or both.  The direct cause often may not be known.  The medication needed to control seizures may cause birth defects.  Such defects may include changes in the face, fingers, and nails.  other birth defects linked to seizure disorders include:

	Cleft Lip or palate (the lip or roof of the mouth is not completely closed)
	Heart problems
	Neural tube defects (such as spine defects)

      Babies born to women with a seizure disorder may be at higher risk for certain health problems:

	Low birth weight (small baby)
	Small head
	Delays in growth and development
	Bleeding (blood-clotting) problems

      Children of women with a seizure disorder are at an increased risk for having seizure disorder themselves.  The reason for this unclear.

 

 

AFTER THE BABY IS BORN

     After delivery, you may find the need to once again adjust your medication.  You also will want to choose a method of birth control.  many AEDs change hormone levels in your body.  This can affect how well birth control methods work.  The use of some AEDs may make birth control pills not work as well.  You may need to change your method of hormonal birth control.  You may want to use a barrier method (diaphragm, spermicide, or condoms) along with the hormonal method.  Talk with your doctor about your AED and its effect on your birth control choices.

 

 

BREASTFEEDING

     Most women with a seizure disorder can breastfeed their babies.  AEDs are found in small amounts in breast milk, but in most cases this is not enough to affect the baby.  Some medications may make babies sleepy or cranky.  If this happens, talk with your doctor and your baby's doctor.  You may wish to use bottle feedings also.  You may choose to pump and store your breast milk.  Breastfeeding may disrupt your sleep patterns.  This can affect seizure activity.  You may wish to have someone else-a partner, friend, or family member bottle-feed the baby at night with breast milk.  Before you stop breastfeeding, discuss it with your doctor.

 

 

FINALLY...

     Most women with a seizure disorder who become pregnant will have a healthy pregnancy and a healthy baby.  Good care before and while you are pregnant is key.  Working with your doctors to maintain careful control of seizures is vital.

 

 

ACOG PATIENT EDUCATION