Epilepsy and pregnancy

Before pregnancy
Pregnancy planning by women with epilepsy should be done in consultation with their attending physician. This will allow to find the optimal balance with the frequency (and type) of seizures, the antiepileptic medication used and the potential impact of other risk factors on the development of the fetus. Folic acid should be taken before conception – this will help mitigate the risks.
After pregnancy
Pregnancy can be generally determined between week 4 and week 6. Changing the therapy to mitigate risks of anomalies of the fetus at this point is practically impossible. In this case it is recommended to discuss ongoing risks and further diagnostic methods with the consulting physician.
Screening and tests during pregnancy
Between weeks 14 and 22 of gestation, ultrasound inspection can be used to examine the fetus with the amniotic fluid and determine the possible development abnormalities. This inspection is done by the gynecologist.
Labor
A woman with epilepsy is capable of independent natural childbirth unless she has contraindications (i.e. frequent seizures). Otherwise, delivery is done via caesarian section.
After childbirth
If the doctor had to increase the patient’s drug dosage during pregnancy, it should be noted that after childbirth, the substance’s concentration in the blood may rise significantly which may lead to symptoms of overdose.
Breastfeeding the baby is mandatory and its replacement is only considered in extreme cases, when a baby starts suffering from drowsiness caused by the drug.
In the first months following childbirth, the patient’s nighttime sleep may be affected due to having to care for the baby. This may cause the seizure situation to deteriorate. In this case, part of the chores related to caring for the child has to be assumed by the father or another person, especially during night time hours.
It is recommended to care for the baby and swaddle on a bed or on the floor to avoid the baby falling from a height in the event that the mother suddenly has a seizure. It is also recommended to employ additional help when bathing the child in a bathtub.