Epilepsy in pregnancy
Most women with epilepsy have a normal healthy pregnancy. There are some precautions you can take to ensure that you and your baby remain as safe as possible. There are many different types of epilepsy which will need to be assessed in order to give you the best chance of a healthy outcome.
Ideally your epilepsy should be well controlled. Any medication you take should be reviewed before you embark on a pregnancy.
Women who have stable epilepsy and have not had a seizure for at least a year before becoming pregnant have the best chance of having a trouble free pregnancy, birth and post natal period.
We advise that you continue with your usual anti-epileptic drugs, at the usual doses you have been prescribed, throughout the time you are trying for a baby, the whole duration of the pregnancy and after the baby is born.
If you do have a short seizure (less than 5 minutes) in pregnancy, the baby usually remains unaffected.
Sometimes the pregnancy can affect the way your medication works and we may need to adjust the dose you are taking. This decision is usually taken in conjunction with a neurologist (a specialist doctor in epilepsy).
Before becoming pregnant
We generally advise that you take a higher dose (5mg) of folic acid than usual which needs to be prescribed by a doctor (eg your GP). You should start this about 3 months BEFORE you stop using contraception in order that your body stores are built up. This is because many of the drugs used to treat epilepsy can lower your stores of folic acid, and low stores can be associated with the baby having spina bifida. Fortunately, the chance of spina bifida is low however it is an important condition for your baby’s development.
Anti epileptic medication in pregnancy
Most anti epileptic drugs are safe to use in pregnancy however there may be a small additional risk of congenital malformations for babies exposed to these drugs. The background chance of a congenital malformation is higher than most people realise (around 2-3%) in the general population. Whereas the chance of this in women taking anti-epileptic drugs is in the order of 3-4%, depending on the drug(s) used and the dosage. The exception to this is a drug called sodium valproate, and women taking this medication are advised to avoid pregnancy. For some women however, sodium valproate is the best drug to control their epilepsy, and special advice can be given for those women who wish to become pregnant.
What to expect once your are pregnant
When you do become pregnant, you will usually be referred to a consultant obstetrician’s team with experience in looking after women with epilepsy in pregnancy. As a precaution, you will be advised to birth in the consultant led Labour ward. However if your epilepsy is well controlled and there are no other significant obstetric factors, it is usually possible to have a low intervention birth, this can include labour in water if wished. Pain relief options are the same as for other women, with the exception of pethidine, which is usually avoided as it can promote seizures in susceptible women. Other opiates, such as morphine, appear to be safe, as is gas and air and epidurals. The chance of having a seizure in labour is low, around 4%. By ensuring your remain as comfortable as possible, manage triggers such as tiredness and dehydration, we can try and help you avoid any complications.
There is a national UK wide Register for women with epilepsy in pregnancy. If you are happy to register, this helps us improve the care we give as it is an area that is very difficult to research. The website to register can be found at www.epilepsyandpregnancy.co.uk. Only you can register, your doctor is not able to do this on your behalf. The website www.epilepsy.org.uk also provides helpful information.
What to do if you have a seizure
If you have a seizure lasting more than 5 minutes you are advised to attend the hospital immediately, as occasionally these types of seizures can lead to further problems. Similarly, if you experience a deterioration in your seizure control it is really important that you report it to your neurology/obstetric team so that we can arrange urgent review. There is a very rare, but dangerous, condition in epilepsy called SUDEP, and uncontrolled epilepsy in pregnancy is known to slightly increase the chance of this. We really do want to help you and your baby to have the very best chance of a healthy pregnancy and birth.