Epilepsy and pregnancy

Posted on May 12th, 2015

The combination of epilepsy and pregnancy might seem dangerous; however, most women who have epilepsy deliver normal, healthy babies. Here’s what you need to know. By Licia Selepe

According to Epilepsy South Africa, while there is a slightly higher than normal risk of birth defects in the babies of women who have epilepsy, the great majority of mothers (92%) on anti-epileptic medication, give birth to normal, healthy babies.

Mother of three boys, Ginnie Ferreira, was diagnosed with epilepsy at the age of 16, and found it difficult to accept and deal with it. “I had no knowledge about this disorder and it terrified me. No one in our family, or even in my small town knew much about it. “I felt ashamed, and didn’t want to talk to anyone about it,” she says. Ginnie only learned to deal with her epilepsy after marrying her husband at the age of 27. “My husband was very supportive and helped me deal with it, and soon after, we started planning to have children,” she adds.

Getting pregnant with epilepsy

National social development manager of Epilepsy South Africa, Karen Robinson, says that women with epilepsy have a slightly higher risk of reduced fertility. This may be due to having epilepsy itself, or to taking certain anti-epileptic medications. Some anti-epileptic medications may affect the hormone levels in your ovaries, which can affect reproductive functioning.

Ginnie didn’t have difficulty falling pregnant. “A year after getting married, I fell pregnant with my first son,” she says. Karen advises that if you’re living with epilepsy and thinking about having a baby, it’s best to discuss the matter with your doctor. “This will allow you to gather all the information you need in managing your epilepsy, and to consider any treatment changes you may need to make before pregnancy begins,” says Robinson.

Seizures during pregnancy

For some pregnant women, their epilepsy is unaffected, while others may see an improvement in their condition. Although many mothers who have seizures have perfectly normal babies, seizures during pregnancy can be dangerous. They can result in falls or lack of oxygen to the baby, and can increase the risk of miscarriage and stillbirth. And as pregnancy can cause physical and emotional stress, seizures may become more frequent and severe. Karen says the best was to manage epilepsy during pregnancy is to see your doctor regularly and take your medication as prescribed. “You should report any seizures or incidents which have occurred, such as falls, vomiting, illness or injury, to your doctor,” she adds.

Ginnie shares her experiences: “With my first two pregnancies, I didn’t have any seizures and everything was normal. I had natural births without any problems. When I fell pregnant for the third time, I had no cause of concern, based on my experience with my previous pregnancies. Little did I know how differently my body would react to the third pregnancy, as I was older by then.
“I had frequent seizures and was in and out of hospital throughout my pregnancy. Everyone feared for both me and my child’s health. I was only concerned about the life I was carrying. To manage my seizures, I had to to take it easy, stay on a balanced diet, and take my medications as prescribed. My doctor monitored me closely until I gave I birth via C-section. I couldn’t risk delivering naturally, in case I had seizures during delivery.”

Your medications

Any medication you take during pregnancy can affect your baby. It’s therefore always advisable to speak to your doctor about the medications you are taking before becoming pregnant, as it may need to be changed to minimise the risks to your baby. “Some anti-epileptic medications can affect the growing foetus, so it’s essential that this be checked out with your doctor as soon as possible. Generally, it’s preferable to remain on medication, with the small risks this may carry, rather than to withdraw all drugs and risk losing control of your seizures, which might endanger your baby,” say Karen.

As your pregnancy progresses, your metabolism will change, too. By the time you are nine months pregnant, the blood volume in your body is 50% greater than it was before you fell pregnant. This means that the anti-epileptic medications in your body will be more diluted. That’s why your doctor will be monitoring the levels of medication in your blood throughout your pregnancy, and might increase the dosage if it gets too low.

Some anti-epileptic medications can reduce Vitamin K in the bloodstream, which can affect blood clotting. In such cases, the doctor may recommend that Vitamin K be taken by the mother before delivery. Some drugs are known to increase the risk of neural tube defect, such as spina bifida. If your anti-epileptic medication dosages are altered for pregnancy, talk to your healthcare provider about returning to your pre-pregnancy levels shortly after delivery, in order to continue keeping your seizures under control and your medication at safe levels.

Expert tip: It is advisable that all pregnant women, but particularly those with epilepsy, to take a folic acid supplement during pregnancy.

Labour and birth

Your labour and delivery are not likely to be different from that of other mothers. Seizures don’t commonly occur during labour, but many women with epilepsy worry that they‘ll have a seizure during labour. If seizures are prolonged, your healthcare provider might deliver the baby via C-section. If you have frequent seizures during your third trimester, your healthcare provider might recommend an elective C-section to avoid the risk of a seizure during labour.

Risks for the baby

Children whose parents have epilepsy have a slightly higher risk of developing epilepsy. The lifetime risk of developing epilepsy in the general population is approximately 3%. If the father has epilepsy and the mother does not, the risk to the children is only slightly higher than 3%. If the mother has epilepsy and the father does not, the risk is somewhat higher, but it’s still under 5%. The highest risk is in women with primary generalised epilepsy. If both parents have epilepsy, the risk is a bit higher than if only one parent has the condition. All of Ginnie’s boys, for example, are perfectly healthy, with no sign of epilepsy.

Caring for your baby

Many women with epilepsy worry about what will happen if they have a seizure while holding their baby, or how anti-epileptic drugs might affect the baby during breastfeeding.

Breastfeeding: This is encouraged even for women who have epilepsy and are taking anti-seizure medication. The likelihood of your baby being affected by anti-epileptic drugs present in your milk will depend on the medication you take. “Very little of the drug is passed on to the infant and should not pose a problem. In fact, it may be a way of weaning your baby off the medication that would have been absorbed during pregnancy.
“For those women who tend to have seizures without warning, it is advisable that you take precautions while feeding your baby. You could try sitting on the floor with your back to the wall, surrounded by cushions,” says Karen.

Bathing and changing your baby: Using a bath stand could be risky, so it’s best to put the baby bath on the floor. If you feel this is still too risky, and there is no one to assist you, it may be best to sponge wash your baby down on a waterproof sheet. Changing your baby in the cot or on a blanket on the floor is a good idea. By kneeling to the side, you will fall away from your baby should a seizure occur. Keep plenty of nappies and other supplies on every floor of your house, so you won’t have to climb stairs as often.
You may want to arrange for another person to help you out until your child is a bit older. Even if your seizures are under control, you should still take precautions to protect your baby, although you may not need someone else with you as often or for as long.

For more information on epilepsy, visit Epilepsy South Africa’s website: www.epilepsy.org.za or contact them on 0860 374 537 or [email protected].