Pregnancy with Epilepsy: Understanding the disease & it’s Management

Pregnancy is a beautiful journey for any woman, but for those with epilepsy, it comes with certain challenges for woman & doctor both. Epilepsy requires careful planning and management.

 Epilepsy is a neurological disorder characterized by recurrent seizures(fits), makes process of pregnancy and childbirth complex.

 Epilepsy coexists with 0.5 percent of pregnancies. Usually women know about their diagnosis of epilepsy prior to pregnancy.

Here we need to understand the effects of epilepsy on pregnancy, as well as effects of pregnancy on epilepsy & management to ensure a safe and healthy pregnancy.

 Effects of Epilepsy on Pregnancy:

Women with epilepsy may face specific issues during pregnancy

Seizure Frequency:

Pregnancy doesn’t have definitive effect on epilepsy. Some women report an increase in seizures, some says, their condition improved in pregnancy & few says there is no change in health condition.

Risks to Mother and Baby:

 Seizures during pregnancy is accompanied with risks to both, mother & baby, such as trauma from falls. Prolonged seizures bring poor outcome for mother & baby.

Epilepsy itself increases the risk of congenital malformations which is multiplied by teratogenic effects of Anti-Epileptic therapy.

 If mother has Epilepsy & father doesn’t then the risk is less than 5 in 100 , if both parents are suffering with Epilepsy then risk is bit higher.

Effects of Pregnancy on Epilepsy

 Pregnancy can influence epilepsy in several ways:

 Medication Metabolism:

 The body's metabolism changes during pregnancy. The pregnancy alters the drug pharmacokinetics possibly by interference in absorption in intestine & because of hemodilution.

 Careful Monitoring Needed:

 Frequent anti natal visits are important for maternal & fetal wellbeing. Close monitoring of mother and fetus is essential to manage any changes in seizure frequency or medication needs.

Antiepileptic Medication:

Managing epilepsy during pregnancy involves the need to control seizures with minimizing risks to the developing fetus.

Antiseizure/Antiepileptic medication:

 Certain Antiepileptic drugs carry higher risks of birth defects. Doctors carefully weigh these risks against the benefits of seizure control.

Folic Acid Supplementation:

 Women taking Antiepileptic medication, are often advised to take folic acid before and during pregnancy to reduce the risk of neural tube defects.

 Management of Pregnancy with Epilepsy:

Managing epilepsy during pregnancy requires a multidisciplinary approach involving neurologists, obstetricians, and specialized epilepsy clinics. Key considerations include:

Pre-conception Planning:

 Planning for pregnancy ideally starts before conception. The patient should be on minimum effective dose of antiepileptic medication, preferably on a single drug therapy. Woman should start taking Folic Acid pre- pregnancy.

Regular Monitoring:

Antenatal screening for congenital malformations in early pregnancy & anomaly scan at 18 to 20 weeks & especially echocardiography at 22 weeks for detection of cardiac defects is necessary. The risk of seizures increases during labor & postpartum period. Therefore mother should be closely monitored during these times.

Healthy Lifestyle & support:

Along with medical treatment, lifestyle adjustments play significant role in management of patient.

 Opting a healthy lifestyle, regular sleep patterns, knowing & avoiding triggers, can help in reducing seizure frequency. Family, friends, and epilepsy support groups, can provide emotional support and assistance.

Breast Feeding:

Breast feeding isn’t contraindicated because a small amount of anticonvulsant medication is secreted in breast milk. Women should be counselled about breast feeding before baby birth. Prefer to breast feed baby before taking your medication.

Contraception:

If woman prefer Combined Oral Contraceptive Pill then dose of these contraceptive pills should be adjusted by doctor carefully. The Contraceptive Hormones are less effective when taken with Antiseizure medication.

Mini Pill or Progesterone Only Contraceptive Pill is not recommended when you are taking antiseizure medication.

Contraceptive Implants are less effective with antiseizure drugs.

Here are few Contraceptive Methods, not Affected by Antiepileptic Medication are following

• Condoms

• Diaphragms

• Contraceptive Injections

• Intra Uterine Devices

 While CONCLUDING I will say, Pregnancy with epilepsy demands careful planning and management to ensure the well-being of fetus & mother. With multidisciplinary approach & help of family and friends, many women with epilepsy can have successful pregnancies. However, each patient is different, and decisions regarding their management are also different. By understanding the effects of epilepsy on pregnancy and vice versa, women can have safe & healthy pregnancy.