Epilepsy and Pregnancy

There are many issues for women with epilepsy, not least planning a family. In this article we outline topics you should discuss with your Doctor or nurse specialist, and show you where to get more information.

It is always recommended that pregnancies are planned, allowing parents time to make informed decisions for themselves and their baby. This is even more important for women with epilepsy.

Pre-conception counselling is an opportunity for you to discuss with your G.P. or Specialist Nurse how your epilepsy will be managed during pregnancy. Your current condition and the risks and benefits of treatment will be reviewed. Further investigations or changes to your medication may be suggested, so ideally, these discussions should be started six months before getting pregnant.

Until you are ready to conceive it is important to ensure your contraception is effective. Your doctor will discuss the options with you, however some antiepileptic drugs can reduce the effectiveness of the oral contraceptive pill. These are Carbamazepine, Lamotrigine, Oxcarbazepine, Phenobarbitone, Phenytoin, Primidone, Topirimate. If you have any concerns about the effectiveness of your contraception use a barrier method until you can see your G.P. or family planning clinic. Do not stop taking the medication for your epilepsy.

Are there any risks of taking medication for epilepsy during pregnancy?
Women who do not have epilepsy have a 3% chance of having a baby with a significant abnormality. This goes up to 6-7% for mothers taking one medication for their epilepsy. Your Doctor, Specialist Nurse or the UK Pregnancy register will be able to give you specific information about your medication. Once you are pregnant it is unlikely that your medication will be changed unless there is a clinical reason. The aim is to keep the number of seizures as low as possible. It is important not to stop taking your medication suddenly as the risks of sudden, uncontrolled seizures is thought to be greater than those associated with taking medication during pregnancy.

What are the benefits of taking medication during pregnancy?
Some women will find their epilepsy is not completely controlled, taking medication can reduce the number of seizures during pregnancy. Many women who are controlled on medication may not want to risk the changes to their lifestyle, such as loosing their driving licence if breakthough seizures occur after their medication is adjusted. Again, discussion with a health professional may help you and your partner make the right choice for you.

Are there any things I can do?
Plan your pregnancy and complete any investigations or medication changes before getting pregnant.

You are strongly advised to take 5mg Folic Acid once a day for three months pre-conception and at least the first three months of pregnancy. This is a higher dose than normal and is only available on prescription from your G.P. Follow the advice for all mothers. Enjoy a healthy lifestyle. Eat a well-balanced diet, exercise, avoid alcohol and don’t smoke. There is some evidence that reducing your caffeine intake helps too.

Once you are pregnant inform your G.P. and Consultant as soon as possible. They will arrange your anti-natal care. The Princess Anne Hospital in Southampton runs a specialist clinic for women with epilepsy. An increase in the number of seizures is unlikely during pregnancy, but is often caused by factors such as not taking your tablets or lack of sleep; so concentrate on looking after yourself well. It is usually advised that you give birth in hospital; so that if necessary, they can help you manage your pain control and prevent you getting too tired. They can also manage any seizures that may occur during labour, although the risk if this is very low, (1-4%). During labour it is important to keep taking your medication at your usual times (tell your birthing partner it is their job to remind you!) and try not to go long periods without eating or drinking. As with any new baby it is worth spending some time planning for your return home. An increase in seizure frequency is unlikely in the first few months after the baby is born. However most women find sleep deprivation and forgetting to take their tablets are the most common causes should they have a seizure. You may want to consider some common sense safety precautions, particularly if your seizures are not fully controlled. If your seizures are sudden and frequent you may wish to feed the baby sitting on the floor supported with cushions. Wash and change the baby on the floor and give them a bath when someone else is in the house. Use a car seat when carrying them up and down stairs. Your midwife or epilepsy nurse can discuss specific issues and the National Associations have large amounts of useful information on their websites. Most importantly, don’t be afraid to ask for help or advice.

National guidelines on the management of epilepsy can be found at:   www.nice.org.uk/cg020, www.nice.org.uk/cg020 and www.sign.ac.uk/guidelines (number 70). What happens if I get pregnant unexpectedly?

Don’t panic! Don’t stop your medication suddenly as this may cause you to have a seizure. Start taking folic acid and see your G.P. as soon as possible for the appropriate ante-natal screening.

Will my baby inherit epilepsy?
In general the chances are low, however some factors will increase the risk, such as the type of epilepsy the parent has, and whether the mother, father or both have epilepsy. Seek advice on your particular circumstances.

Will I be able to breastfeed my baby?
In most cases, yes. If your baby is premature, you have recently made medication changes, or your baby seems unusually sleepy seek advice from the medical team. Your baby will already have had 9 months to get used to the medication, so the small amount in breast milk does not usually cause problems. If you choose not to breast feed, some women add their breastmilk to formula feeds for a few days if the baby seems agitated or jittery.

The following associations and groups have further information regarding issues for women, pregnancy and childcare.

NATIONAL SOCIETY FOR EPILEPSY. Tel: 01494 601 400 or 0808 800 5050 www.epilepsynse.org.uk

UK PREGNANCY REGISTER. Tel: 0800 389 1248