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Epilepsy and Pregnancy: Keeping Your Baby Healthy

Posted Aug 24 2008 1:49pm

ANNOUNCER: It is estimated that 90 percent of babies born to women with epilepsy are normal and healthy. But pregnancy can present women with epilepsy with a variety of challenges, including changes in seizure patterns.

CYNTHIA HARDEN, MD: Pregnancy itself can have an effect on a woman's seizure activity. It does seem to occur, sometimes, that women, when they get pregnant, may have an increase in seizures. On the other hand, there seems to be a small group of women for whom pregnancy is very stabilizing and they don't have seizures.

ANNOUNCER: Any seizure during a pregnancy needs to be reported to a physician, because seizures have been associated with an increased risk of several different complications.

BLANCA VAZQUEZ, MD: Seizures during pregnancy are not welcome. A seizure will put at risk the placenta to have low oxygen levels and low blood flow. If the mother falls or if she has an accident, having a complex seizure, that can also put the baby at risk. So it's very important that, during pregnancy, we are proactive preventing any type of seizures.

ANNOUNCER: Seizures during pregnancy have also been associated with miscarriages.

CYNTHIA HARDEN, MD: This is related either to the trauma of falling during a seizure or to the severe cardiovascular sort of event that it is and that can deprive the placenta of blood and decrease fetal heart rate.

ANNOUNCER: Seizure activity is also largely affected by a woman's anti-seizure drug regimen. Typically women and their neurologists work to reduce the number of medications a woman takes, as well as the frequency and dose, in preparation for the pregnancy. Once pregnant, however, women should not change their regimen.

BLANCA VAZQUEZ, MD: During pregnancy, we do not change anti-epileptic drugs. We do not like to switch to a different agent, because there is no data that will support that that particular medicine is going to protect the patient's seizure. It is safer to maintain the therapy that is known to work and to allow the patient to go to pregnancy following the levels, following a very close monitoring with the obstetrician.

ANNOUNCER: But there are no anti-seizure medications that have been proven completely safe. All anti-seizure drugs have been associated with an increased risk of birth defects. There has been some data to suggest that the newer anti-epilepsy drugs may have less of an effect on the fetus, but that data is not conclusive.

BLANCA VAZQUEZ, MD: Anti-epileptic drugs are known to be teratogenic and that is to affect the unborn child. The major malformations are four: that's neural tube defect like spinal bifida, cardiac malformation, uritogenital malformation -- that's the kidneys -- and the midline defect, which is the closure of the lip and the palate. Those are major malformations which interfere with function of different organs. The minor malformations are more cosmetic and they are less life-threatening.

CYNTHIA HARDEN, MD: We also know that, with higher doses, especially of multiple medications, the risk of birth defects can be even higher.

ANNOUNCER: Hormonal changes and vitamin deficiencies associated with pregnancy can also change the way anti-epileptic drugs work. So it is very important for women with epilepsy to discuss their medication regimen with their doctor to make sure proper drug levels can be maintained throughout pregnancy.

CYNTHIA HARDEN, MD: During pregnancy, a woman's body does alter slightly in the way that she metabolizes medications. For anti-seizure medicine, this, in general, means that they'll be cleared from the body a bit more readily so that the levels may drop a bit.

The level that needs to be maintained is the level at which the woman is doing well and doesn't have seizures. In general, though, the medication adjustment tends to be rather small and is fairly easily managed.

ANNOUNCER: If a woman with epilepsy finds herself with an unplanned pregnancy, there are several things she can do, including taking multivitamins as well as folic acid supplements. There are also several tests that should be done immediately.

BLANCA VAZQUEZ, MD: If a woman comes up to the doctor's office already pregnant in the first trimester, there are certain tests that need to be done. The alpha fetal protein is one of the types of blood tests that we can do. Amniocentesis is another type of blood test that we can do. And ultrasounds can be done. And the OB/GYN will have to partner with the neurologist to decide which studies need to be done. Regularly, they do ultrasounds, and that will give you an idea if there has been any malformation.

ANNOUNCER: Labor and delivery may also increase the risk for seizure and complications although this is rare.

CYNTHIA HARDEN, MD: Seizures during delivery, labor and delivery are uncommon. They are reported to occur in approximately 1 percent, or 1 out of 100 women. I have not seen this happen. I advise my patients to continue taking their medicines during labor, so that they are still protected against seizures by taking medication.

ANNOUNCER: Once the baby is born, woman often have questions regarding the safe care of the newborn. One area of concern is breastfeeding. All anti-seizure medications are present in breast milk and can potentially harm the newborn, although this is uncommon.

CYNTHIA HARDEN, MD: Women with epilepsy are advised that it is OK for them to breast-feed. The benefits of breast-feeding to the baby are thought to outweigh any risks of exposure to anti-seizure medicines.

The main risk of the baby being exposed to any anti-seizure medicine is that it might be slightly sedating for the baby and this is something to watch for. It's pretty hard to tell when a newborn baby is sedated, since they sleep eighteen hours a day. The guideline that we use is that, if the baby doesn't wake up to adequately feed, the baby may actually be sedated from the anti-seizure medicine exposure and this is a situation in which breast-feeding should be possibly reconsidered.

ANNOUNCER: Another area of concern for new mothers with epilepsy is sleep deprivation.

CYNTHIA HARDEN, MD: Lack of sleep will lower the seizure threshold, in general, for all people with epilepsy. So, in this setting, when a woman is pregnant, goes through labor and delivery and then has a newborn baby at home, she's very much at risk for sleep deprivation and, therefore, at risk for having more seizures.

I also advise my patients that they need to be really disciplined about taking a nap when the baby takes a nap. And, when the baby's up, then, of course, they have to be up, but it's so irresistible for new moms to try to get some chores done when the baby finally takes a nap. But I advise my patients that they have to just let it go and get their rest.

ANNOUNCER: Seizures cannot only put the mother at physical risk, but often the newborn as well. There are several things a woman can do to reduce the risk of injury.

BLANCA VAZQUEZ, MD: Domestic accidents are very common for women with epilepsy. In the newborn period, the bathing of the child should be done with another adult. Preparing the bottles should also be done with another adult. We recommend strongly that we don't use the changing tables, because it's a high setup. We should have a mat and change the baby on the floor.

ANNOUNCER: As the child gets older, the issue of a mother's epilepsy needs to be addressed.

BLANCA VAZQUEZ, MD: They need to be made aware that Mom has seizures. Because they often spend more time with Mom than with the father, it is very important that they recognize the seizure signs and know what to do. So it is good to have drills in the house, "What if Mommy has a seizure in the playground? What if Mommy has a seizure and we're alone?" This, obviously, is in the older toddler, older child that can ask for help. It is very important to talk to the child about the condition, because that will minimize their fears.

ANNOUNCER: There are organizations, as well as literature, that can help parents explain epilepsy to their children.

BLANCA VAZQUEZ, MD: There is literature, and there's a book called Mommy Has Epilepsy that talks about what to do and how to instruct your child and how to help your child understand the disease. It is also very important to talk about this with the Epilepsy Foundation. There are certain programs that they can help you with.

ANNOUNCER: In general, a woman with epilepsy whose seizures are well-controlled can look forward to a normal pregnancy, the vast majority of the time. And by involving her doctors in every stage of pregnancy, a woman with epilepsy can further ensure a safe and healthy pregnancy.

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