Epilepsy and Pregnancy: What You Need to Know

Epilepsy is a chronic neurological disorder characterised by recurrent seizures. For women living with epilepsy, navigating pregnancy can present unique challenges. However, with proper planning, appropriate treatment and expert care, most women with epilepsy can experience a safe and successful pregnancy.

Table of Contents

• Understanding the Impact of Seizures During Pregnancy
• Causes of Seizures During Pregnancy
• Epilepsy and Pregnancy Guidelines
• Pregnancy Planning with Epilepsy
• Antiepileptic Drugs in Pregnancy
• Seizure Management During Pregnancy
• Signs and Symptoms 
• High-Risk Pregnancy Epilepsy
• Temporal Lobe Epilepsy and Pregnancy
• Epilepsy and Fetal Development
• Labour and Delivery with Epilepsy
• Breastfeeding and Epilepsy Medication
• Treatment of Epilepsy in Pregnancy
• Conclusion

Understanding the Impact of Seizures During Pregnancy

One of the primary concerns for women with epilepsy is whether seizures during pregnancy can harm the baby. The answer depends on the type, severity and frequency of the seizures. Generalised tonic-clonic seizures, which involve convulsions and loss of consciousness, pose the greatest risk. They can lead to decreased oxygen supply to the baby, miscarriage, premature birth or low birth weight.

Having a seizure while pregnant, especially one that causes falls or injuries, may increase the risk of trauma to the mother and the fetus. If you experience your first seizure during pregnancy, it is vital to seek medical attention immediately. In some cases, seizures may result from pregnancy-specific conditions such as eclampsia – a severe complication of preeclampsia.

Causes of Seizures During Pregnancy

Seizures during pregnancy can be triggered by various factors, including hormonal changes, sleep deprivation and stress. Hormonal fluctuations can affect seizure thresholds, especially in women with temporal lobe epilepsy, a type of focal epilepsy originating in the temporal lobe of the brain. Additionally, pregnancy-related changes in the body may alter how antiepileptic drugs (AEDs) are metabolised, potentially leading to breakthrough seizures.

Epilepsy and Pregnancy Guidelines

The National Institute for Health and Care Excellence (NICE) offers comprehensive guidelines for epilepsy in pregnancy. These emphasise individualised care, early intervention and multidisciplinary management. Women planning a pregnancy with epilepsy should consult their healthcare provider well in advance. This allows for medication adjustments, preconception counselling and optimisation of seizure control.

Pregnancy Planning with Epilepsy

Pregnancy planning with epilepsy is crucial to ensure the health and safety of both mother and baby. Women are advised to take folic acid supplements before conception, as folic acid epilepsy pregnancy research shows it can help reduce the risk of neural tube defects associated with some AEDs.

Healthcare providers often recommend pre-pregnancy counselling to review the woman’s medical history, current epilepsy management and any potential risks. This stage is essential for tailoring treatment plans, assessing epilepsy pregnancy risks and discussing the implications of continuing or adjusting medications.

Antiepileptic Drugs in Pregnancy

One of the most significant challenges in managing epilepsy during pregnancy is balancing the benefits of seizure control with the potential risks of antiepileptic drugs in pregnancy. While some AEDs are associated with an increased risk of birth defects, the risks of uncontrolled seizures often outweigh the risks of medication.

The choice of medication should prioritise the safety of both mother and baby. Epilepsy medication safety during pregnancy depends on selecting the lowest effective dose of a single drug, whenever possible. Valproate, for example, is strongly discouraged due to its high risk of congenital malformations and developmental delays. Newer-generation AEDs such as lamotrigine and levetiracetam are often preferred because of their lower teratogenic potential.

Seizure Management During Pregnancy

Seizure management during pregnancy involves close monitoring of both the mother and the fetus. Regular prenatal visits are essential to track the health of the pregnancy and make any necessary adjustments to the treatment plan. Epilepsy prenatal care often includes frequent blood tests to monitor medication levels, as pregnancy can alter how the body processes drugs.

Women should also avoid known seizure triggers, maintain a regular sleep schedule and manage stress effectively. In some cases, healthcare providers may recommend additional scans or tests to monitor fetal development and ensure the baby is not affected by seizures or medications.

Signs and Symptoms of Epilepsy in Pregnancy

The signs and symptoms of epilepsy in pregnancy are similar to those experienced outside of pregnancy. These include sudden changes in behaviour, confusion, staring spells or convulsions. However, women should report any new or unusual symptoms to their healthcare provider promptly. This is especially important for distinguishing epilepsy-related symptoms from pregnancy complications such as eclampsia.

High-Risk Pregnancy Epilepsy

Pregnancy with epilepsy is often classified as high-risk, requiring specialised care from a multidisciplinary team that may include obstetricians, neurologists and midwives. High-risk pregnancy epilepsy care focuses on minimising the risk of seizures, monitoring fetal health and ensuring the safety of labour and delivery.

Women with poorly controlled epilepsy or those experiencing frequent seizures during pregnancy may require additional interventions. In rare cases, hospitalisation may be necessary for closer monitoring.

Temporal Lobe Epilepsy and Pregnancy

Temporal lobe epilepsy poses unique challenges during pregnancy. This type of epilepsy often involves complex partial seizures, which may not cause convulsions but can still impact maternal and fetal health. Women with temporal lobe epilepsy may need medication adjustments to maintain seizure control while minimising side effects.

Epilepsy and Fetal Development

Epilepsy and fetal development are closely linked, as both seizures and medications can potentially affect the baby. While most babies born to mothers with epilepsy are healthy, the risk of developmental delays or congenital abnormalities is slightly higher than in the general population. Careful monitoring and adherence to epilepsy and pregnancy guidelines can help mitigate these risks.

Labour and Delivery with Epilepsy

Labour and delivery with epilepsy require careful planning to ensure the safety of both mother and baby. Women should discuss their birth plan with their healthcare provider, including options for pain management and strategies for managing seizures during labour.

The risk of seizures during labour is relatively low, particularly for women who have maintained good seizure control throughout pregnancy. However, intravenous AEDs may be administered if there is a heightened risk of seizures. In rare cases, a caesarean section may be recommended, but most women with epilepsy can have a normal vaginal delivery.

Breastfeeding and Epilepsy Medication

Many women with epilepsy can safely breastfeed while taking AEDs. Breastfeeding and epilepsy medication considerations depend on the specific drug and dosage. While some AEDs are excreted into breast milk in small amounts, the benefits of breastfeeding generally outweigh the potential risks.

Healthcare providers can help assess the safety of breastfeeding and recommend strategies to minimise drug exposure to the baby. For example, breastfeeding immediately before taking medication may reduce the amount transferred through breast milk.

Treatment of Epilepsy in Pregnancy

The treatment of epilepsy in pregnancy is highly individualised, focusing on optimising seizure control while minimising risks to the baby. This includes selecting safe and effective medications, monitoring for side effects and providing supportive care.

Women with epilepsy should never stop or adjust their medication without consulting a healthcare provider, as uncontrolled seizures can pose a significant risk to both mother and baby.

Conclusion

Epilepsy and pregnancy require a delicate balance of managing the mother’s health while safeguarding the baby’s development. With proper epilepsy prenatal care, medication management and adherence to guidelines, most women with epilepsy can achieve a healthy pregnancy and delivery.

If you are planning a pregnancy with epilepsy or have concerns about managing epilepsy during pregnancy, consult with an expert Lenmed obstetrician and neurologist early to ensure the best possible outcomes for you and your baby. With the right care, living with epilepsy need not hinder your journey to motherhood.

For more information, please contact:

Dr TE Nakanyane
Discipline: Gynaecologist, Obstetrician
Hospital: Zamokuhle Private Hospital
Telephone: +27 11 923 7804 / 011 923 7804