How to manage epilepsy in females during pregnancy?

Question

Hello Doctor,

My wife is 29 years old and has epilepsy. We are planning to have a baby, but we are very worried about the risks of birth defects and other complications because she is taking medicine to control her seizures. We want to know which seizure medicines are the safest during pregnancy, and how her treatment plan should be adjusted before we try to conceive.

We are also concerned about the possibility of her having a seizure during labor. What will happen if she has a seizure while giving birth? Her neurologist mentioned that Folic acid is essential for women with epilepsy. Can you explain why, and how much she should take? What kind of special care and monitoring will she need during pregnancy to protect her health and the baby’s health?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Planning a pregnancy while managing epilepsy requires close coordination between you, your wife’s neurologist, and an obstetrician experienced in high-risk pregnancies. Some seizure medicines can increase the risk of birth defects, especially in the first three months of pregnancy. Safer options during pregnancy include Lamotrigine and Levetiracetam, both of which have a lower risk of causing birth defects. Medicines such as Valproic Acid, Topiramate, and Phenytoin carry higher risks and are usually avoided or used only if necessary. It is essential to consult her neurologist about her current treatment. If a change in medication is needed, it should be done before conception and only under medical supervision to prevent uncontrolled seizures.

Folic acid is also extremely important for women with epilepsy who are planning to get pregnant. A high dose of folic acid between 4 and 5 milligrams per day should be started at least one to three months before conception and continued through the first trimester. This helps reduce the chance of brain and spine defects in the baby, which are more common with some seizure medicines.

Keeping seizures under control during pregnancy is essential for both mother and baby. Uncontrolled seizures can lead to injury, lack of oxygen, or early labor. Fortunately, if epilepsy is well managed, seizures during labor are uncommon. However, the hospital team will be prepared with early intravenous access and medications like Lorazepam or Midazolam in case a seizure occurs. The anesthesia and delivery teams will monitor her closely, and a cesarean section is not automatically needed unless there are specific complications or her seizures are not well controlled.

Throughout the pregnancy, she will need special care and frequent monitoring. This includes regular prenatal checkups, an ultrasound around 11 to 13 weeks for early screening, and a detailed scan between 18 and 22 weeks to look for any birth defects. Seizure medicine levels should be checked often because pregnancy can affect how the body handles medications. Keeping a seizure diary is helpful. If she is taking enzyme-inducing drugs like Phenytoin or Phenobarbital, she may need Vitamin K in the last month of pregnancy to reduce the risk of bleeding in the baby.

After the baby is born, breastfeeding is usually safe, especially if the mother is taking Lamotrigine or Levetiracetam. Her seizure medicines should be continued because a lack of sleep can trigger seizures. It is important to have good support at home to ensure the baby's safety in case she has a seizure.

Schedule a pre-pregnancy visit with both her neurologist and obstetrician. If needed, change to a safer seizure medicine under medical guidance. Begin taking 4 to 5 milligrams of Folic acid daily if not already started. Plan for regular monitoring and choose a hospital that is well-equipped to handle epilepsy during delivery. With proper care and planning, your wife can have a safe pregnancy and a healthy baby.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.