Many women with epilepsy are worried about possible risks in becoming pregnant. Women with epilepsy who become pregnant do have a higher risk for complications than women who do not have epilepsy. This includes the possibility of having more frequent seizures, which can cause pregnant women to become sleepy or fall, possibly causing serious injury. Other women experience a decrease in the frequency of their seizures when they are pregnant.
Most women do not see any change in the frequency of their seizures when they are pregnant. Increased seizures are usually seen in women who do not take their antiepileptic drugs (AEDs) as the doctor prescribes. Epilepsy may also occur for the first time in pregnancy.
The body processes AEDs differently during pregnancy. This can lead to medication levels that are too high (which can cause side effects) or too low (which can cause more seizures). Blood levels of medication usually become lower with the weight gain of pregnancy, and your neurologist will probably have to increase your dosage to limit unnecessary seizures. It is important to control seizures during pregnancy because it is safer for the baby and the mother. As stated previously, pregnant women who have epilepsy should not stop taking their AEDs without permission from their doctor. Each woman who has epilepsy will react differently to pregnancy and childbirth, and your doctor will discuss any possible risks, and monitor you and your fetus closely.
It can be useful for the medical team that is assisting with the birth to be aware of your medical history as it relates to your epilepsy disorder, such as medication and seizure types.
Tonic-clonic seizures (convulsions with muscular rigidity) can cause miscarriage or injury to the baby in rare circumstances. Only 1% to 2% of women with uncontrolled epilepsy will have a tonic-clonic seizure in labor; 1% to 2% will have some type of seizure in the 24 hours after birth. Medication can be used to control seizures in the event one occurs during labor.
Pregnant women with epilepsy who want to have a home birth need to consider the complications that could arise if a seizure occurs during labor. Water births also need to be carefully considered, because consciousness may be impaired during seizures. A water birth can be performed at home or at a birthing center. The warm water relaxes the mother’s back and pelvic muscles and takes the weight of the baby off the mother’s back and hips. Relaxation, combined with the buoyancy of water, helps the baby descend through the birth canal. A water birth can provide a relaxing transition for the baby from the womb into the world.
Potential obstetrical complications that are seen more frequently in women with epilepsy include vaginal bleeding, anemia, and hyperemesis gravidarum (HG), a rare disorder characterized by severe and persistent nausea and vomiting during pregnancy that may necessitate hospitalization. As a result of frequent nausea and vomiting, affected women experience dehydration, vitamin and mineral deficit, and the loss of greater than 5% of their original body weight. Difficulties during labor and delivery include premature labor, failure to progress, and an increased rate of cesarean section, which may become necessary to protect the well-being of the mother or baby.
Approximately 1 million women of childbearing age in the United States have epilepsy. Complications may arise during conception and pregnancy that involve the choice of AED, when to take the medication, and how to control seizures. These complications have social as well as medical ramifications for pregnant women and their families. During pregnancy, factors such as the choice of AEDs for seizure control, hormonal changes, and vitamin deficiencies can have some bearing on seizure patterns, even for women who have had excellent seizure control before becoming pregnant. These complications, combined with genetic factors, can also lead to a greater risk of major and minor birth defects for babies born to women with epilepsy. Although this risk is not usually significant enough for neurologists and epileptologists to advise their patients against pregnancy, health care specialists support a careful and cautious pregnancy for all women who have or have had epilepsy.
As stated earlier, the number of seizures remains unchanged during pregnancy for most women. However, about 20% will experience an increase in seizures during pregnancy. Some women experience seizures only during birth. The physiologic changes that may play a role in the increased incidence of seizures for some women include changes in hormone production, metabolism, stress, and alteration in sleeping patterns.
The hormones estrogen and progesterone increase naturally and steadily during normal pregnancy. Estrogen has been shown to be epileptogenic (increasing seizure activity), and progesterone is thought to have an anti-seizure effect. Fluctuations in the levels of these hormones can make it more difficult for mothers who are epileptic to predict and control their seizures.
Generally, sleep deprivation influences seizure frequency for those who have epilepsy. A significant increase in seizure occurrence may result during pregnancy when sleep patterns change. Stress and the associated changes in eating and sleeping habits may also contribute to an increase in seizures for some women.
In most cases, the level of AEDs in the blood decreases during pregnancy despite adherence to the proper dosage. For many women, this does not result in an increase in seizures. In the majority of instances in which seizures increase, the levels of AEDs in the blood are found to be lower than the recommended therapeutic range. It is therefore very important to monitor medication levels closely during pregnancy.