The great majority (about 90%) of pregnant women with
epilepsy give birth to normal, healthy babies. However, there are increased
risks to both mother and child that you need to consider and discuss with your
doctor - ideally before conception.
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1. Seizures during pregnancy Most
women with epilepsy will have no change in their seizure frequency during
pregnancy. Some women have a decrease in seizures and some may even stop having
them altogether. About a quarter to a third of women will have increased numbers
of seizures during pregnancy, despite continued use of anti-epileptic
medication.
Concentrations of seizure medication in your bloodstream
may change or decrease during pregnancy, putting you at greater risk for
seizures. Your physician will most likely need to check blood levels of your
medication more often, and may need to adjust your dose. Some seizure increase,
particularly early in pregnancy, may be due to a woman cutting down her
anti-epileptic medication, for fear of harming the foetus.
Although many mothers who have seizures have perfectly
normal babies, seizures during pregnancy can be dangerous. Seizures can result
in falls or lack of oxygen for the mother and thus the baby, and increase the
risk of miscarriage and stillbirth.
Status epilepticus (repeated seizures without return to
consciousness in between) is potentially fatal for both mother and child: this
is why women with epilepsy who find themselves to be unexpectedly pregnant
should never suddenly stop medication.
For all the above reasons, it is important to reduce the
number of seizures you have during pregnancy by consulting your doctors, taking
your medication as prescribed and avoiding likely seizure triggers.
2. Birth defects Women with
epilepsy have a slightly increased risk of having a baby with a birth defect.
Women in the general population have about a 2-3% chance of having a baby with a
significant birth abnormality; this increases to about 4-8% if the woman has a
history of epilepsy.
Severe abnormalities are those that will need treatment
after birth or lead to long-term problems for the child. Examples of these are
malformations of the spinal cord and spine (spina bifida), malformations of the
heart (e.g. hole in the heart), and cleft palate and lip (portions of the mouth
do not grow together properly).
Other minor birth defects primarily
affect the baby's appearance (so-called "dysmorphic features"). These include
facial abnormalities (e.g. eyes set too wide apart or a short upper lip), and
small fingers and toes with rudimentary nails. These minor abnormalities do not
cause any serious problems, although there is some concern that children born
with dysmorphic features may show later evidence of impaired intellectual
development.
The increased risk for birth defects may be in part due
to anti-seizure medications. However, the current general consensus among
medical experts is that the risks associated with having a seizure during
pregnancy far outweigh the risk of birth abnormalities. Most women with epilepsy
should continue their seizure medication, and whenever possible, take a single
anti-epileptic medication at the lowest dose that provides seizure control.
Never stop taking your medication or change the dose without the supervision of
your doctor. If you haven't had any seizures for two years or more, your doctor
may consider it appropriate to try slowly stopping your seizure medication.
You may wish to ask your physician for a referral to a
specialist in genetic conditions, who can help in assessing the possible risks.
This expert can also recommend tests, such as ultrasound or amniocentesis, which
can identify some types of birth defects.
3. Minor complications of
pregnancy Women with epilepsy have a slightly higher risk for minor
complications of pregnancy, such as morning sickness, toxaemia (raised blood
pressure and protein in the urine) and vaginal bleeding.
4. Other potential problems related to
pregnancy Babies of mothers with epilepsy may have a slightly
greater risk of developing seizures, and delays in growth and development.
There is also an increased risk for problems at birth as
early or difficult labour, and bleeding.
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