What are the pregnancy risks for women on epilepsy medicines?

Question

Hello doctor,

My friend has epilepsy and has been on anti-seizure medications for years. She wants to get pregnant soon, but we are worried about the risks. Kindly answer my following questions:

Do anti-epileptic drugs harm the baby or increase the chances of birth defects?
Are there any medicines that are safer during pregnancy?
Should she change her medications before trying to conceive?
What about folic acid?
How much should she take?
Can seizures during pregnancy harm the baby?
Are there any special precautions during labor to prevent seizures?
Will breastfeeding be safe on these medications?
If she wants to delay pregnancy for now, which birth control methods are safest?
Do hormonal pills interact with epilepsy drugs?
Is IVF safe for women with epilepsy, or does the hormonal stimulation trigger seizures?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Yes, it can affect the baby if the seizure is uncontrolled and the frequency of seizures increases during pregnancy. All women on antiepileptic drugs should be advised to take 5 milligrams per day of Folic acid prior to conception and to continue the intake until at least the end of the first trimester to reduce the incidence of major congenital malformations.

Prepregnancy, Folic acid 5 milligrams per day may be helpful in reducing the risk of antiepileptic drug-related cognitive deficits. Early pregnancy can be an opportunity to screen for structural abnormalities. The fetal anomaly scan at 18 to 21 weeks of gestation can identify major cardiac defects in addition to neural tube defects.

Women with epilepsy and their partners need to be informed about the possible adverse impact on long-term neurodevelopment of the newborn following in utero exposure to Sodium Valproate.

Based on limited evidence, in utero exposure to Carbamazepine and Lamotrigine does not appear to adversely affect the neurodevelopment of the offspring. There is very little evidence for Levetiracetam and Phenytoin. Parents should be informed that evidence on long-term outcomes is based on small numbers of children.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.