How should women with epilepsy plan before pregnancy?

Question

Hello doctor,

I am a 26-year-old woman with epilepsy and have been on anti-seizure medications since my teenage years. My major concern now is whether these medications can reduce my fertility or harm a baby if I try to conceive. My questions are:

I have heard that some anti-epileptic drugs can cause birth defects. Are there safer alternatives for women who are planning a pregnancy?
I also want to know if seizures themselves can increase risks during pregnancy or labor. Another issue is that my menstrual cycles are often irregular, and I sometimes experience severe cramps before a seizure. Could this be a hormonal connection?
Is it safe for women with epilepsy to use hormonal birth control methods, such as pills or implants, or do these interfere with seizure medications?
I am also concerned about breastfeeding after delivery. Will my anti-seizure medications pass into breast milk and affect my baby?
Is IVF considered safe for women with epilepsy if natural conception is difficult?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Yes, seizures can affect the baby if they are uncontrolled, and seizure attacks may increase during pregnancy.

All women taking anti-epileptic drugs should be advised to take 5 mg/day of Folic acid prior to conception and to continue this intake until at least the end of the first trimester to reduce the incidence of major congenital malformations. Pre-pregnancy Folic acid at 5 mg/day may also help reduce the risk of AED (anti-epileptic drug) related cognitive deficits.

Early pregnancy is an opportunity to screen for structural abnormalities. The fetal anomaly scan at 18 weeks and 0 days to 20 weeks and 6 days of gestation can identify major cardiac defects as well as 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 baby. There is very little evidence regarding 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.