Pregnancy and epilepsy

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With good prenatal care, 90% of women with epilepsy, who do fall pregnant, end up having healthy babies.

It’s essential that there’s good communication between your neurologist and your gynaecologist to help you through this phase of your life. While planning is important for all women who want to have babies, it’s even more so in the case of women who have epilepsy.

Some women with epilepsy may, however, experience greater difficulty than other women in falling pregnant. There’s a connection between two specific hormones and epilepsy: oestrogen and progesterone. Oestrogen increases the electrical activity of the brain, and progesterone decreases it.

Is it more difficult for epileptic women to fall pregnant?

It’s a double-edged sword, as the effectiveness of epilepsy treatment may be influenced by a woman’s hormonal state, and a woman’s hormonal state may be affected by epilepsy treatment.

In rare instances women can experience heightened risk of seizures in the perimenstrual period. However, it’s not certain that this is sufficient to have a major effect on the effectiveness of epilepsy treatment.

Epidemiological studies suggest that female and male fertility is moderately reduced in patients suffering from epilepsy. Why this is so is less certain. Potential factors include the effect of anti-epileptic medication on sex hormones, but also epilepsy itself, comorbid depression and psychosocial factors.

Some anti-epileptic medications, i.e. valproate and gabapentin, can increase appetite and thereby lead to weight gain. Overeating can cause obesity. Obesity can be associated with PCOS, which is frequently associated with menstrual irregularities.

Men who take certain anti-epileptic medications, i.e. carbamazepine and phenytoin, can be associated with lower testosterone levels, affecting libido, erectile function and sperm count, which could make it more difficult for their partners to fall pregnant. The reason for this is not certain.

A low sex drive in both men and women with epilepsy could be caused by anxiety or depression, or because of side effects of certain AEDs.

Certain AEDs, such as carbamazepine, phenytoin, phenobarbitone, oxcarbazepine, topiramate in higher dosages, can speed up the liver metabolism and thereby lower the effectiveness of hormonal birth-control methods.

When using these drugs, hormonal birth control can become ineffective. Additional contraceptives, i.e. barrier methods, are recommended when exposed to even a single-dose administration of the above medications.

Hormone substitution can reduce lamotrigine levels and thereby increase the risk of seizures when taking lamotrigine.

AEDs and the health of your baby

Many women with epilepsy worry about the effect their anti-seizure medication could have on their unborn babies. While there are certainly risks involved, which will be discussed below, it must be remembered that the prevention of seizures during pregnancy remains important, as uncontrolled seizures could deprive the unborn baby of oxygen.

There are risks when taking any seizure medications – a baby could be born with a cleft palate, bone abnormalities, and heart and urinary tract defects. While this sounds very serious, it must be stressed that pregnant women who take AEDs run a risk of 4% to 6% of having a baby with birth defects. The general risk for all babies is between 2% and 3%. This risk is probably highest in patients using valproate, as well as in patients whose epilepsy is only controlled by high dose or multiple drugs. The use of valproate in pregnancy has also been associated with impaired cognitive development of the child.

It’s never a good idea to stop taking or taper off AEDs without consulting your doctor. For most women with epilepsy, it’s recommended that they stay on their AEDs during pregnancy, but that you might need to change your types of AED in consultation with your doctor, preferably before you fall pregnant. There’s no AED that works for everyone and for all types of seizures, so a detailed discussion of your particular needs and concerns is necessary before you fall pregnant.

It’s essential to try and keep seizures under control, also during pregnancy. Blood levels of anti-epileptic medications can change during pregnancy; therefore dose adjustments may be necessary.

Many women also worry that their children could inherit the epilepsy. This depends on many factors, such as the type of epilepsy a woman has, whether the epilepsy has a genetic cause, and whether your partner also has epilepsy.

Of all babies who are born, 1% run the risk of becoming epileptic. This increases slightly to between 2% and 5% for children whose parents have epilepsy.

Epilepsy and possible pregnancy complications

The experience of pregnancy is different for every woman, and this is also true for pregnant women with epilepsy. Unfortunately, women with epilepsy have a higher risk of pregnancy-related complications, such as morning sickness, high blood pressure (preeclampsia), anaemia, premature birth, or a low-weight baby. There also appears to be a slight increase of perinatal mortality in infants born to women with epilepsy compared with controls.

It can also happen that during labour delivery, the progress stops, possibly making a Caesarean section necessary. For most women with epilepsy, seizures don’t become more frequent during pregnancy, or while giving birth. In women with poorly controlled epilepsy, seizures can sometimes become more frequent.

The risk of having a seizure during the birth process doesn’t appear to be majorly increased. It is, however, still advisable for anyone who has epilepsy to have her baby delivered in a hospital with a medical team on standby.

Most experts believe that breastfeeding isn’t generally contraindicated in patients taking AEDs, as probable benefits outweigh risks. Certain anti-epileptic medication (benzodiazepines, phenobarbitone) can have a sedating effect on the baby. It’s best to consult with your doctor.

- (Susan Erasmus, Health24)

References: Nhs.uk; Mayoclinic.org; Epilepsy Foundation; Epilepsysociety.org.uk

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