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Questions to Ask Your Doctor About Epilepsy/Seizures
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Management and Pregnancy

In addition to the traditional means of promoting healthy pregnancy, such as proper nutrition, exercise, good sleep, and substance avoidance, there is a disease-specific regimen often prescribed to mothers afflicted with epilepsy.

Early planning, management, and education is especially essential for all women of childbearing age who suffer from epilepsy. It is best if prior to conception, when pregnancy is being planned, that a woman see her physician, and that a full evaluation is performed. A thorough neurological exam is necessary to teach women all the major issues of potential concern. Women might consider involving an epileptologist or a neurologist who has experience treating issues and complications surrounding pregnancy, as well as an obstetrician. Ultimately, an epileptic woman must have the right to make an educated decision regarding conception. Indeed, the risks often deter couples from having children. However, should an epileptic woman decide to conceive a child, she can utilize several management strategies to reduce the risk of abnormal pregnancy and birth.

For example, a major component to healthy pregnancy for sufferers of epilepsy is multivitamin therapy with folate (folic acid). Research has indicated that the use of folate can help minimize the risk of some of the major congenital malformations, specifically those involving the spinal cord.

Even women with a seizure disorder who are not using AEDs (which diminish folic acid levels) during pregnancy should take daily folate supplements. In fact, it is suggested that women should begin folic acid supplementation before conception. Specialists recommend that a minimal dose of 2 mg a day is sufficient to maintain proper folate balance before and during pregnancy.

Compliance with medication is essential. Many clinicians also believe that even before becoming pregnant, if at all possible, women should switch to monotherapy (treatment with just one AED). Doing so, and using the lowest possible dose, can help minimize risks. Again, seizures can potentially affect a developing baby by decreasing oxygen or blood supply to the womb. So the decision to reduce dosage should only be made at the discretion of a physician who understands the biological and physiological patterns of epilepsy.

Many clinicians suggest a thorough ultrasonography examination at 16–18 weeks of gestation. This exam, which produces internal sonographic photos of the fetus, can help rule out spina bifida, limb abnormalities, and heart abnormalities. Amniocentesis, with testing for alpha-fetoprotein (a protein that is elevated in spina bifida), is often suggested for epileptic mothers.

Furthermore, an increase in vaginal hemorrhaging, early labor, and eclampsia (toxemia of pregnancy with postpartum convulsions) has been reported in epilepsy-related pregnancies.

Postpartum Management, Effects, and Incidence
Treatment for epileptic mothers does not stop after birth. Careful monitoring of AED levels should be performed throughout pregnancy and after delivery postpartum. The risk of seizure while attending to a newborn is significant enough for most epileptic parents to create alternative ways of care. For example, parents are often advised to change and feed their babies while sitting in secure, protective areas. Continued medication after pregnancy is especially important, as the effects of proper care now influence a baby who requires it.

Also, there is a chance that a baby born to a woman who has been treated with AEDs will be affected by the medication. Sometimes, newborns experience sedation as well as withdrawal symptoms for the first few weeks of life. Although alarming, these symptoms are usually temporary. They pose no significant medical problem, unless they prohibit the baby from eating properly.

Does AED Treatment Affect Breastfeeding?
Antiepileptic drugs do show up in fairly low levels in breast milk, some higher than others, but pose no serious health threat to a nursing baby. However, physicians often advise caution for mothers who have been treated with certain AEDs that tend to remain at higher levels in breast milk. Generally, mothers with epilepsy can expect to breastfeed their babies without complication, though counseling with an obstetrician is advised.

What Are the Chances that My Baby Will Have Epilepsy?
Because the causes for most types of seizure disorder are varied, the occurrence of epilepsy in children born to epileptic parents varies. Children whose mothers have epilepsy have about a 3% chance of getting the disease. If just the father is affected by epilepsy, the risk is the same as it is for anyone in the general public. If both parents are epileptic, the risk rises to approximately 5%.

Often, those who suffer from epilepsy gain an advanced knowledge of their disease as a result of planning a pregnancy. Certainly, preconception planning is just as important as the 9 months that follow. With the assistance of a physician, women with epilepsy can experience a healthy pregnancy and childbirth.

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