epilepsy-drug-during-pregnancy-linked-to-lower-iqWith careful management, most women with epilepsy can safely give birth to a healthy baby.

If you or someone you love is a woman with epilepsy, then you may be wondering if motherhood is an option. The good news is that in most cases, the answer is yes. But not everyone is aware of the possibilities.

When one of my patients and her husband desired to start a family, they were concerned because her childhood seizures had recently recurred after almost a decade of good control. Now she was having “petit mal” seizures almost every day, causing brief interruptions in her awareness of her surroundings. If Sarah did get pregnant, would her baby be healthy? And if her seizures remained frequent after delivery, would she be able to care for her child?

To her dismay, my patient’s gynecologist recommended avoiding pregnancy altogether. But she and her husband still hoped that having a family might be possible. They decided to consult with a specialist in neurology and epilepsy medicine, and to their relief, the new doctor expressed a different opinion. She explained that with modern treatment and careful management, most women with epilepsy can safely fulfill a pregnancy and give birth to a perfectly healthy baby.

She collaborated closely with her new physician, and together they made several changes in her medications to reduce seizures and minimize risk for the unborn child. Once the changes were accomplished, her seizures came under control. She quickly became pregnant, and nine months later, she delivered a healthy baby boy.

My patient’s experience is not unusual. Over the years, many otherwise healthy women with epilepsy have had the mistaken impression that motherhood is not an option. Now we know that with careful medical management, most women with epilepsy can plan for motherhood with confidence.

It may seem counter-intuitive, but for women experiencing epilepsy, the first step is actually family planning. It is important to prevent an accidental pregnancy until after several safeguards are in place, to ensure that risks to the unborn child are as low as possible. Some commonly-used antiepileptic medications interact with oral birth control pills in an unfavorable way, and in this case, it is wise to consider other alternatives. A conversation with your doctor will help you decide which contraceptive method is best for you.

During the planning period for your pregnancy, your doctor will take a fresh look to be sure that your medical diagnosis is up-to-date. He or she may wish to recheck your EEG, or electroencephalogram, brain wave test, and possibly perform some other testing. It will certainly be recommended that you start taking folic acid and a prenatal vitamin daily. And if you are experiencing active seizures, or if you are taking a medication associated with an increased risk of harm to the unborn child, then you may be advised to make changes in your daily regimen. The adjustment process will continue until you and your doctor are confident that your seizures are under the best-possible control, with minimal risk to the baby.

Once your baby is on the way, your doctor will closely monitor the levels of antiepileptic medication in your bloodstream, as these often change throughout pregnancy. The doses may need to be increased as pregnancy progresses, and then reduced again after delivery. Close collaboration between you, your neurologist and your obstetrician will ensure that your drug levels remain stable throughout the pregnancy and after your baby arrives, and that your seizures remain under the best-possible control.

For some women with severe epilepsy or other serious health challenges or disabilities, pregnancy may not be advisable. But we are happy to report that thanks to modern health care and medications, most women with epilepsy are just as likely to achieve pregnancy and deliver healthy babies as anyone else.
Source: U.S. News and World Report
Article by: Elaine Wyllie, MD, professor, Cleveland Clinic Lerner College of Medicine, is a world-renowned thought leader in neurology and epilepsy at Cleveland Clinic’s Neurological Institute.