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Q: How does epilepsy affect pregnancy?
A: Women who have epilepsy face a higher risk of pregnancy-related complications, including:
• 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
Q: Does epilepsy change during pregnancy?
A: 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.
Q: What about medication?
A: 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 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 healthcare 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.
Q: What does my epilepsy mean for my baby?
A: 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.
– Source: GeorgiaHealthInfo.gov
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Mary Katherine Albritton had a normal childhood despite being diagnosed with epilepsy when she was 6 years old. Her parents worked to teach her about her condition, and she grew up to be a happy adult. But in 2005 she got a surprise: she was pregnant. As an adult with epilepsy, she wondered about the risks to her and her fetus.
“I had six seizures through my pregnancy, but my daughter Taylor was born a healthy, beautiful baby,” says Albritton, who worked closely with her neurologist throughout the course of her pregnancy.
Albritton is just one of a surprisingly large number of women with epilepsy who have had successful childbirths. It is estimated that about half a million women with epilepsy in the United States are of childbearing age and that three to five out of every 1,000 births are to women with epilepsy. The majority of people with epilepsy have well-controlled seizures, are otherwise healthy and expect to participate fully in life experiences, including pregnancy.
New guidelines developed by the American Academy of Neurology and the American Epilepsy Society show it's relatively safe for women with epilepsy to become pregnant, but caution must be taken, including avoiding valproate, an epilepsy drug that can cause birth defects.
“Good evidence shows that valproate is linked to an increased risk for fetal malformations and decreased thinking skills in children, whether used by itself or with other medications,” says lead guideline author Dr. Cynthia Harden, director of the Epilepsy Division at the University of Miami's Miller School of Medicine and a member of the American Academy of Neurology.
The guidelines also suggest that, if possible, women with epilepsy should not take more than one epilepsy drug at a time during pregnancy since taking more than one seizure drug has also been found to increase the risk of birth defects compared to taking only one medication.
“Overall, what we found should be very reassuring to every woman with epilepsy planning to become pregnant,” says Harden. “These guidelines show that women with epilepsy are not at a substantially increased risk of having a Caesarean section, late pregnancy bleeding or premature contractions or premature labor and delivery. Also, if a woman is seizure-free nine months before she becomes pregnant, it's likely that she will not have any seizures during the pregnancy.”
However, Harden says pregnant women with epilepsy should consider having their blood tested regularly. “Levels of seizure medications in the blood tend to drop during pregnancy, so checking these levels and adjusting the medication doses should help to keep the levels in the effective range and the pregnant woman seizure-free.”
When Albritton had her second child, Thomas, she had three seizures during her pregnancy. “June 15, 2007, was my last seizure when I was pregnant with Thomas. He was born a healthy baby boy on Nov. 5. When people say their kids are miracles, mine really are. I haven't had a seizure since.”
Her advice for other women with epilepsy who want children: “Understand that epileptic women are capable of having healthy babies. I suggest staying in close contact with your obstetrician and neurologist.”
For more information about the guidelines visit www.aan.com.
– Source: ARA content
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