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Planning for Pregnancy When You Have Epilepsy

Posted Aug 24 2008 1:49pm

ANNOUNCER: Epilepsy and seizures affect approximately one million women of childbearing age in the United States. And the chances are very good that a woman with epilepsy will give birth to a healthy baby, and a well-planned pregnancy can reduce the risk of complications.

TRACY GLAUSER, MD: Women with epilepsy do have a higher rate of difficulty getting pregnant, and they also have a higher rate than the general population of having children with some birth defects. It is important to know that the vast majority of children born to women with epilepsy are perfectly healthy and grow up to be perfectly normal.

ANNOUNCER: The best way for a woman with epilepsy to avoid any seizure-related complications, is to discuss and plan her pregnancy with her doctors.

CYNTHIA HARDEN, MD: A woman with epilepsy should prepare and plan for her pregnancy for several reasons. The first and most important reason is that she should not have generalized seizures and preferably no seizures during her pregnancy. It's been shown that they can decrease fetal heart rate and increase the risk of miscarriage. Also just in general, trauma during pregnancy of whatever cause but including falling during a major seizure can really put the pregnancy at risk and cause miscarriage, basically, due to rupture of the placenta from the uterus.

ANNOUNCER: Another reason that a woman with epilepsy needs to plan her pregnancy, is that anti-epileptic medications have been associated with an increased risk of birth defects.

CYNTHIA HARDEN, MD: We do not have a specific anti-seizure medicine at this time that has been shown to be completely safe during pregnancy. The types of birth defects that are associated with anti-seizure medicines are the same as in the general population, and these include the most common sorts of birth defects, like cleft lip, cleft palate; also cardiac defects, holes in the heart, so to speak, or other malformations of the heart; and then spinal cord defects, specifically lack of closure of the lower spinal cord.

ANNOUNCER: Not all anti-seizure medications are associated with all of these birth defects. And there is some evidence that the newer anti-epilepsy drugs pose less risk, although more data is needed.

CYNTHIA HARDEN, MD: There seem to be several that have emerged as possibly being worse than the others. This would include Depakote†, which appears to have a higher risk of the spinal cord defects, and phenobarbital, which recently has been reported to have a higher-than-expected rate of birth defects associated with it and these are largely cardiac.

Outside of these two medications, it's not clear that any of the others are that much different. In addition, with a whole new generation of anti-seizure medicines, although they've been widely used throughout the world, we still don't have enough information to clearly counsel our patients.

ANNOUNCER: As with any pregnancy, women with epilepsy need to re-evaluate their drug regimen with their neurologist.

CYNTHIA HARDEN, MD: When a woman with epilepsy wants to become pregnant, she should consult with her neurologist about the appropriateness of the medication she's on. Perhaps, in some cases, she could even taper off her medication for pregnancy. If that's not the case, then she and her physician need to make sure that she's on an appropriate medication; in some cases, perhaps consider changing to another medication, and at least streamlining the therapy, so that she's on the least number of medications -- hopefully, only one -- and at the lowest possible dose that still provides good seizure control.

ANNOUNCER: But changing a patient's anti-seizure medication can be very risky and can potentially lead to an increase in seizure activity. So, changes should only be made to a woman's drug regimen after careful consultation with her neurologist.

CYNTHIA HARDEN, MD: For a woman to consider coming off medication in anticipation of pregnancy, she needs to have been seizure-free for at least two years on medication and have her EEG normalized. If she's had a very mild seizure disorder that has come under good control readily with anti-seizure medicines and she stayed very well-controlled, this may be a situation in which she could safely taper off her medication.

ANNOUNCER: In general, most women need to stay on their medication through pregnancy.

CYNTHIA HARDEN, MD: In general, the risk of seizures is thought to be greater than the relative low risk of birth defects associated with these medications, particularly when they are used as a single agent, used alone and at the lowest possible dose. So, many times the decision is to stay on their medication during pregnancy, because it's thought to be safer overall.

ANNOUNCER: Outside of taking steps to reduce anti-seizure medications, there are other steps a woman with epilepsy can do to ensure a healthy pregnancy.

CYNTHIA HARDEN, MD: They should make sure they have had adequate nutrition and this includes taking multiple vitamin as well as folic acid at the usual dose of about 1 milligram per day before conception.

ANNOUNCER: The bottom line is, if a woman with epilepsy is able to adequately control her seizures prior to conception, she can usually look forward to a safe and healthy pregnancy. And planning the pregnancy with her neurologist's help is key to ensuring that.

CYNTHIA HARDEN, MD: When a woman with epilepsy becomes pregnant, her chance of having a healthy baby is very high. It's well over 90 percent, probably 94 or 95 percent.

TRACY GLAUSER, MD: A woman who has epilepsy needs to communicate clearly and frequently with their health care provider when she intends to become pregnant. Planning a pregnancy is the best way to try and avoid any complications from either the epilepsy or its therapy.

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