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Dr. Sydney Piercey
650 SW 3rd Street, Corvallis OR 97333-4437
Phone: 541-207-3900, Fax: 541-207-3232
http://www.pierceyneurology.com
Epilepsy and pregnancy: Healthy choices for a healthy baby
Most pregnant women who have epilepsy deliver healthy babies, yet concerns remain. Learn the
importance of prenatal care, the risks of medication and more.
Years ago, women who had epilepsy were often discouraged from getting pregnant. Today, the odds are
in your favor. Thanks to early and regular prenatal care, more than 90 percent of pregnant women who
have epilepsy deliver healthy babies, according to the Epilepsy Foundation.
If you're considering pregnancy, here's what you need to know.
Does epilepsy make it more difficult to conceive?
Occasionally seizures may disrupt the signals in your brain that tell your ovaries when to release an egg.
This can affect your menstrual cycle and fertility. Medication may be an issue as well. Some drugs used
to treat seizures can affect fertility.
How does epilepsy affect pregnancy?
Women who have epilepsy face a higher risk of pregnancy-related complications, including:
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Vaginal bleeding
Premature separation of the placenta from the uterus (placental abruption)
High blood pressure and excess protein in the urine after 20 weeks of pregnancy
(preeclampsia)
Premature birth
Does epilepsy change during pregnancy?
Every woman reacts to pregnancy differently. For most pregnant women who have epilepsy, seizures
remain the same. For a few, seizures actually improve. For others, pregnancy makes seizures worse —
particularly during the first trimester.
What about medication?
Any medication you take during pregnancy can affect your baby. Birth defects — including cleft palate,
neural tube defects, and heart and neurological problems — are the major concern for seizure
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Dr. Sydney Piercey
650 SW 3rd Street, Corvallis OR 97333-4437
Phone: 541-207-3900, Fax: 541-207-3232
http://www.pierceyneurology.com
medications. But without medication, uncontrolled seizures pose more serious threats for your baby, such
as oxygen deprivation. Sometimes, seizures may cause miscarriage or stillbirth.
A few women can safely taper off their medication before pregnancy. For most women, however, it's best
to continue treatment during pregnancy. To minimize the risks for you and your baby, your health care
provider will prescribe the safest medication that's effective for your type of seizures. No single
medication is best for everyone.
As your pregnancy progresses and your blood volume increases, your kidneys may remove the seizure
medication from your system more quickly than previously. Severe nausea and vomiting during early
pregnancy may upset the balance as well. Frequent dosage adjustments may be needed to maintain
seizure control.
What does my epilepsy mean for my baby?
Babies born to mothers who have epilepsy have a slightly higher risk of developing seizures as they get
older. Developmental and growth delays are possible as well.
For babies whose mothers take seizure medication, the risk of birth defects is 4 percent to 8 percent —
compared with 2 percent to 3 percent for all babies, according to the Epilepsy Foundation. The risk
seems to be highest when multiple seizure medications are taken.
What should I do to prepare for pregnancy?
Before you try to conceive, schedule an appointment with the health care provider who'll be handling your
pregnancy. Also meet with other members of your health care team, such as your family doctor or
neurologist. They'll evaluate how well you're managing your epilepsy and consider any treatment changes
you may need to make before pregnancy begins. Take your seizure medication exactly as prescribed.
Don't adjust the dose or stop taking the medication on your own.
It's also important to make healthy lifestyle choices.
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Eat healthy foods.
Take prenatal vitamins.
Exercise regularly.
Keep stress under control.
Get enough sleep.
Avoid smoking, alcohol and illicit drugs.
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Dr. Sydney Piercey
650 SW 3rd Street, Corvallis OR 97333-4437
Phone: 541-207-3900, Fax: 541-207-3232
http://www.pierceyneurology.com
Do I need more folic acid than other pregnant women do?
Folic acid helps prevent neural tube defects, serious abnormalities of the brain and spinal cord. Because
some seizure drugs affect the way your body uses folic acid, your health care provider may recommend a
high-dose folic acid supplement — ideally starting three months before conception.
What can I expect during prenatal visits?
During pregnancy, you'll see your health care provider often. Your weight and blood pressure will be
checked at every visit, and you may need frequent blood tests to monitor your medication levels. During
the last month of pregnancy, your health care provider may recommend oral vitamin K supplements to
help prevent bleeding problems in the baby after birth.
What if I have a seizure when I'm pregnant?
Seizures can be dangerous, but many mothers who have seizures during pregnancy deliver healthy
babies. Report the seizure to your health care provider. He or she may adjust your medication to help
prevent other seizures. If you have a seizure in the last few months of your pregnancy, your health care
provider may monitor your baby at the hospital or clinic.
How can I make sure my baby is OK?
Your health care provider will closely monitor your baby's health throughout the pregnancy. Frequent
ultrasounds may be used to track your baby's growth and development. Depending on the circumstances,
your health care provider may recommend other prenatal tests. What you learn may help you understand
the odds and make important decisions about your pregnancy.
What about labor and delivery?
Most pregnant women with epilepsy deliver their babies without complications. Because stress may
increase the risk of seizures, a calm environment and epidural anesthesia are often recommended. If you
have a seizure during labor, it may be stopped with intravenous medication. If the seizure is prolonged or
your labor doesn't progress normally, your health care provider may deliver the baby by C-section.
Will I be able to breast-feed my baby?
Breast-feeding is encouraged for most women with epilepsy, even those who take seizure medication.
It is okay to breast-feed. If you decide not to breast feed don’t blame it on you epilepsy or meds ;)
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Dr. Sydney Piercey
650 SW 3rd Street, Corvallis OR 97333-4437
Phone: 541-207-3900, Fax: 541-207-3232
http://www.pierceyneurology.com
IN HOSPITAL:
Have your Trileptal level checked on admission.
Level can often go down quickly if you are given a lot of fluids.
Also with delivery your body can retain fluid all by itself.
For this reason we need a back up plan.
Take Trileptal as directed.
However if you feel anything suggested of an aura take: Valium 2.5mg by mouth or IV quickly and repeat
up to 4 times every 10 minutes until that feeling stops.
Find a physician:
Dr. Rong Wong, Dr. Guempal….just a couple of idease  Corvallis Clinic: 541- 757-3757
Good Samaritan Hospital 1-800-863-5241
Pregnancy and Women with Epilepsy
Posted on August 1st, 2007 by Brent
David G. Vossler, M.D.
Epilepsy Center at Washington Neuroscience Institute
Renton, Washington
Pregnancy is probably the most complex issue for women with epilepsy (WWE). One-half of 1%
of all pregnancies occur in women with epilepsy. The pregnant WWE must balance the risks
posed by seizures with the risks associated with antiepileptic drug (AED) exposure. Seizure
frequency is increased in roughly one-third of women during pregnancy, but it remains the same
in another third, and may actually decrease in another third.
A major concern is pregnancy complications. WWE whose seizures are poorly controlled have
higher rates of toxemia, vaginal bleeding, premature labor, failure to progress in delivery, and
cesarean section. The infants have higher death rates, decreased fetal growth and health, and a
higher risk of intrauterine growth retardation. Well-treated patients, however, mostly have
typical pregnancies and deliveries. Therefore, planning ahead for pregnancy with your healthcare provider and keeping your seizures as well-controlled as possible with the proper
medication are both extremely important.
A factor associated with an increase in seizure frequency as pregnancy progresses is changes in
AED pharmacokinetics. Pharmacokinetics refers to how drugs move into, through, and out of the
body. As pregnancy progresses, body volume, kidney drug clearance, or liver drug metabolism
may increase, resulting in a decrease in the total AED blood levels. Total blood levels are only
part of the story: A few AEDs, like phenytoin (Dilantin, Phenytek) and valproate (Depakote), are
highly bound to blood proteins like albumin. Changes in protein binding during pregnancy can
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Dr. Sydney Piercey
650 SW 3rd Street, Corvallis OR 97333-4437
Phone: 541-207-3900, Fax: 541-207-3232
http://www.pierceyneurology.com
alter the ratio of the free blood level to the total blood level. It is the free level that accounts for
the AEDs antiseizure benefits and side effects. Also, natural pregnancy hormone changes cause
some AED levels, like lamotrigine (Lamictal), to fall to as low as 33% of normal in the third
trimester. As a result of these various changes, neurologists often regularly monitor AED blood
levels throughout pregnancy.
In completely healthy women without epilepsy, major birth malformations (teratogenesis) occur
in roughly 2-3% of infants. Research studies have variably estimated that major malformations
affect 3.5-6% of infants born to mothers with epilepsy; minor abnormalities affect 6-20%. From
1996-2005 the U.K. Epilepsy and Pregnancy Register (UKEPR) studied 237 WWE untreated
during pregnancy and found a major malformation rate of 3.5%. Major malformations include
cleft palate/lip, spina bifida, and congenital heart disease. Minor abnormalities include widespaced eyes, epicanthal folds, nasal growth deficiency, abnormal ears, low hairline, distal finger
and toe development, small fingernails, and others. Some conditions causing epilepsy, such as
tuberous sclerosis and malformations of cortical development, are associated an increased risk of
defects.
All of the older AEDs are associated with an increased risk of birth defects. The North American
AED Pregnancy Registry (NAPR) has reported that the major malformation rate in babies born
to WWE taking one of the older AEDs was 6.5% for phenobarbital and 10.7% for valproate
(NAPR report, Winter 2006). There is evidence that the use of more than one AED, and higher
doses of either valproate or lamotrigine, increase the risk of congenital malformations (UKEPR
2006, and NAPR 2006). For the newer AEDs (ones approved by the FDA since 1993) some data
are emerging. For lamotrigine, the NAPR and several other international registries are estimating
a major malformation rate around 2.9%, with a mild increase in cleft lip and cleft palate in some,
but not all, registries.
Data presented at the April 2007 American Academy of Neurology annual meeting by Dr.
Kimford Meador and the Neurodevelopmental Effects of AED (NEAD) group showed that at
age 2 years, children exposed in the womb to valproic acid had significantly lower scores on the
Mental Developmental Index compared to children exposed to carbamazepine, lamotrigine, or
phenytoin. The negative impact of valproate was related to the dose. Further information on the
long-term effects of AEDs on the intelligence of children will come from this important ongoing
study.
Folic acid 2 – 4 mg/day and one prenatal vitamin per day are recommended before and during
pregnancy, to reduce the risk of congenital malformations. A high-level detailed ultrasound and a
“quad screen” blood test are often recommended during weeks 16-20 of pregnancy. Close
monitoring of AED blood levels during pregnancy can be important because generalized tonicclonic seizures can cause physical injury or asphyxia to the fetus or miscarriage.
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Dr. Sydney Piercey
650 SW 3rd Street, Corvallis OR 97333-4437
Phone: 541-207-3900, Fax: 541-207-3232
http://www.pierceyneurology.com
Another risk to infants with older AEDs like phenytoin is decreases in vitamin K levels in
mother and baby. This can lead to serious hemorrhages in infants. In Washington State, infants
do receive an intramuscular injection of vitamin K. However, it is recommended that vitamin K
10 mg/day should be taken orally during the last 1-4 weeks of pregnancy with older AEDs. This
may be less of an issue with newer AEDs. Practice parameters have been published by the
American Academy of Neurology (Epilepsia 1998;39:1226-31).
All of the older antiepileptic drugs, and some of the newer antiepileptic drugs, cross into breast
milk to some degree. Some of them, such as primidone (Mysoline), cross extensively over into
breast milk. A physician should be consulted about whether or not nursing should occur, but in
most cases nursing is usually recommended for infants already exposed to the AED in the womb.
In summary, much is known about pregnancy in epilepsy. However, much still needs to be
learned, especially with the newest medications. Planning ahead for pregnancy can greatly
reduce the risk of many of the risks and adverse outcomes listed above. For example, it may be
possible to change from riskier medications, such as valproate, to other less risky ones. Also,
working with your health-care provider, it may be possible to get seizures under better control
before becoming pregnant. Once you are pregnant, careful frequent consultations with
knowledgeable health-care professionals to monitor your seizures and AEDs, run needed tests,
and ensure you get the proper vitamins and good general care can help the vast majority of
WWE have successful, safe pregnancies and healthy babies.
These are general guidelines that should not be taken as specific advice, for women with
epilepsy. Please consult your physicians about all of these issues. These points are made for
discussion only, and to encourage further research and investigation into these issues.
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