Pregnancy and epilepsy: seizures and how to minimize them

Epilepsy is one of the most common neurological diseases diagnosed among women of childbearing age. In the United States of America, over a million women have been reported with reproductive epilepsy. More than 24,000 children with the same diagnosis are born in perinatal centers every year, namely, up to five children per thousand births. Pregnant women with epilepsy generally feel normal, and specific complaints rarely occur. 

Most of the patients give birth to healthy children, pregnancy does not affect the course of the disease and the change in symptoms. The frequency of attacks remains the same. To minimize the risk of complications during pregnancy, an individual treatment regimen is selected for each patient. Personalized therapy, selected for a woman during this period, will not only improve the prognosis for the mother, but also reduce the risk of developing a disease in the unborn child.

Frequency of seizures during pregnancy

According to medical statistics, in many women, the frequency of seizures during pregnancy remains the same or decreases. The period of bearing a child does not in any way affect the appearance of new signs of epilepsy or aggravate the condition of the woman in labor. An increase in seizures is observed in up to 30% of cases in the first or third trimester of pregnancy, in which the body is more susceptible to changes.

It is not possible to predict the change in seizure frequency based on the patient’s history. The duration of the course of the pathology and the increase in the frequency of attacks during the previous pregnancy also does not affect the woman’s condition at the moment. The situation can change at any time. Some patients have catamenial epilepsy. With this diagnosis, women experience or become more frequent with attacks during certain phases of the menstrual cycle. Even with this form of the disease, it is impossible to predict an increase in the frequency of epileptic seizures during pregnancy.

The following factors affect the frequency of seizures:

• nervous tension or emotional swings;
• disturbed water-salt metabolism;
• disturbed hormonal levels or changes in hormonal levels;
• a decrease in the level of antiepileptic drugs in the blood.

The expectant mother is advised to monitor the quality of sleep and the adherence to the prescribed course of treatment. If you experience frequent drowsiness or insomnia, you should definitely consult your doctor. It is strictly forbidden to correct the treatment yourself. During the entire pregnancy, the patient is obliged to visit an epileptologist who will monitor the condition and monitor changes. Only in this case can the occurrence of complications and the risk of congenital fetal anomalies be prevented.

Risk of fetal abnormalities as a result of seizures and antiepileptic drugs

If a pregnant woman has seizures, there is a risk. The risk entails taking antiepileptic drugs that affect the functioning of internal organs. Some drugs are completely prohibited for pregnant women and for the lactation period. The likelihood of risk for a seizure depends on the type of seizure. Focal seizures are not dangerous. When it comes to generalized tonic-clonic seizures, the risk increases both for the health of the expectant mother and for the child.

The negative impact occurs when injuries sustained as a result of a burn or a fall from a height. In such situations, the risk of premature birth, fetal abnormalities, miscarriage, and suppressed fetal heart rate increases. Health professionals say that seizure control is essential, especially during pregnancy. According to epileptologists, the health risk of having seizures is more dangerous than the risk of taking antiepileptic drugs. If there are side effects when taking medications, it is possible to minimize the intake, or refuse such treatment. It is impossible to foresee the occurrence of seizures.

The use of antiepileptic drugs during pregnancy without the knowledge of the doctor often leads to the formation of congenital anomalies or developmental defects. Congenital malformations in infants are diagnosed in only 3% of cases. Such abnormal changes are difficult to prevent or predict. In pregnant women with epilepsy, the risk of having a baby with a developmental defect doubles to 6%. In general, according to medical statistics, there are few such cases.

The risk increases markedly if polytherapy is performed . We are talking about taking several medications and, at the same time, the dose is increased. Genetic predisposition is of considerable importance. If developmental defects were diagnosed during a previous pregnancy or in a family history, the risk of pathology also increases during the current pregnancy.

There are such malformations that are most often observed:

• cleft lip;
• heart disease;
• defect of the genitourinary system;
• cleft palate;

Some of the above malformations are treated surgically and permanently. We are talking about external pathologies. There is little information about the safety of antiepileptic drugs, as each organism is different. If the remedy can help one patient and minimize the risk of complications, then the other has serious side effects. Medical professionals prefer classic antiepileptic drugs that have fewer side effects.

Most antiepileptic drugs are considered safe and do not pose any threat to the health of the mother and the life of the child. However, some drugs do have a specific increased risk. For example, ” Valproate ” when used in the first trimester of pregnancy in 2% of cases, causing the development of neural tube defects. The risk is reduced if the expectant mother takes folate during the neural tube closure in the first month of pregnancy.

You should take folate daily from the moment you conceive. The drugs will not have the same effect on patients with epilepsy, but will significantly reduce the risk of developing congenital abnormalities. Most patients do not know about the onset of pregnancy until the closure of the neural tube. Daily intake of vitamins containing at least 0.4 milligrams of folate significantly improves the prognosis for women of childbearing age.

Eating sleniuma on a permanent basis, and zinc will also benefit for the future of the mother and her baby. In the last trimester of pregnancy, it is advisable to take vitamin K1 in order to prevent hemorrhages in the newborn, which sometimes happen.

Strategies to minimize risk

It is imperative that the expectant mother is supervised by a qualified doctor throughout the pregnancy. The medical worker will give the woman the necessary and accurate information regarding the intake of medications, lifestyle changes. It is recommended to use medications with the lowest dose of antiepileptic drug. Then the risk of developing pathologies will be minimized.

Monotherapy or taking a single drug will reduce the risk of congenital abnormalities and abnormalities. Side effects, drug interactions will be significantly reduced. Compliance or the relationship between the doctor and the patient plays a significant role . During pregnancy, constant monitoring of the level of drugs in the blood is carried out. Epileptic drug levels are monitored during the three trimesters and after the baby is born. According to medical statistics, during pregnancy, the level of antiepileptic drugs decreases. Therefore, the dose of admission is selected for each patient in different ways.

The level of drugs in the blood rises after childbirth, so monitoring this indicator is necessary to prevent side effects. The obstetrician-gynecologist is obliged to monitor the condition of the fetus. For this, ultrasound diagnostics is performed or maternal serum alpha- fetoprotein is determined . Most women with epilepsy give birth naturally, as this diagnosis is not an indication for a cesarean section.

Antiepileptic drugs pass into breast milk, which is why many women refuse to lactate. Health professionals say that in most cases, breastfeeding will not pose a danger to the child, since during pregnancy the future fetus has already been exposed to antiepileptic drugs. The absolute amount of the drug in milk is minimal.

Taking antiepileptic drugs immediately after feeding the baby is designed to minimize the drug during feeding. The lactation period is of great value for the child and affects the state of immunity.

For women with epilepsy, it is recommended to visit a doctor before conceiving a child and to plan a pregnancy. For this, a number of diagnostic studies of the patient’s body are carried out. Throughout pregnancy, drug monitoring of antiepileptic drugs in the blood is carried out . Attention is also paid to good sleep, the diet of the expectant mother and rest. Weight gain is monitored, the woman must take a complex of vitamins with folates during pregnancy and after the birth of a child. Subject to all the rules, a pregnant woman will be able to give birth to a healthy and strong child.