Knowing the Potential Risks for a Satisfactory Outcome
Motherhood is one of the most important stages of life, and in women with epilepsy, it warrants further consideration. Most women with epilepsy are able to have normal and healthy pregnancies, however caution and extra monitoring is advised. Improvement in management strategies has shown that pregnancy during epilepsy can be safe, as long as seizure management is done properly.
Occasionally, seizures which may occur during pregnancy may cause accidents, deprivation of oxygen to the baby or miscarriage. The greatest of these risks mostly happen during the tonic clonic type of seizures because of the high potential of trauma. The changes in sex hormones, psychological stress factor and disturbances in sleep may trigger the seizures; but there are women who do not experience any changes to their seizures during pregnancy.
Pregnancy causes increased blood volume and metabolism, thus the dosages of ASMs (anti-seizure medication) for seizure control may become irregular. Regular follow ups with a doctor is critical to ensure the wellbeing of the growing fetus. Some ASMs pose a high risk of fetal malformations to the fetus, like neural tube defects and mental disability. Women with epilepsy should meet with a health care provider to assess their risk and consider safer ASMs prior to conception. Women with epilepsy should never stop their ASMs without medical consultation.
Preconception planning is very important in women with epilepsy. It includes assessment of the factors related to seizure control and/or the medications taken to judge whether these changes are advisable. There should be additional intake of folic acid supplementation prior to the conception as a measure to eliminate the possibilities of neural tube defect. Follow up appointments during gestation will include follow up of levels of ASMs in order to ensure adequate medication dosage and seizure control.
Fatigue, stress, and sleep deprivation are key triggers, and strategies should be employed to minimize these triggers. Maintaining healthy hydration, proper nutrition, adequate sleep, and managing stress during pregnancy presents an additional challenge for individuals with epilepsy.
It is observed that the majority of women with epilepsy can have a normal vaginal delivery; nevertheless, cesarean section may be advisable if the patient has increased seizures. It is necessary to draw up a plan for delivery with clearly defined actions that will prevent or reduce the risk of a seizure. Women may experience higher seizure incidence after delivery due to sleep deprivation, stress, and other factors, hence the need to receive adequate assistance from all loved ones around them. Most of these women should be able to breast-feed with the ASMs however, there are likely some medications which must be avoided
It is essential to realize that pregnancy in women with epilepsy is a challenge that needs thorough preparation and management, but under the appropriate medical care, such women can deliver healthy children. It is critical to discuss ideal ASM choice prior to conception and monitor the pregnancy closely in order to minimize the risk of seizures.
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