Pregnancy in Women with Epilepsy

Preparing for pregnancy in a woman with epilepsy is a long-term process that should be discussed and planned in detail, and then implemented well before trying to conceive.

Planning Pregnancy in a Patient with Epilepsy

For most patients with epilepsy, pregnancy proceeds normally, and over 90% of them give birth to healthy children. However, we cannot leave things to chance. We know that uncontrolled epileptic seizures and inappropriately selected treatment carry risks for both mother and child.

It is important that the woman remains under the care of specialists with the necessary knowledge and experience in caring for patients with epilepsy, and the key to safety is planning pregnancy early enough. This gives us the opportunity to optimize treatment, meaning adjusting the type and amount of medication to meet needs during pregnancy. Any change in treatment requires time to assess its effectiveness, and this doesn't happen overnight.

Despite increased awareness and knowledge about epilepsy, about 40% of pregnancies are still unplanned. Ideally, every young woman should receive treatment optimal for potential pregnancy from the moment epilepsy is diagnosed, regardless of when or if she plans motherhood. In practice, however, things often happen differently.

How Should a Patient with Epilepsy Prepare for Pregnancy

There isn't one path, one ideal preparation scheme that we could implement the same way for all women with epilepsy. Each case of epilepsy is different, each patient has different types of seizures, different frequency, and varying effectiveness of medications. Therefore, pregnancy planning is a step-by-step and individually tailored action plan, including:

• optimization of antiepileptic treatment – Your treating neurologist will verify the current treatment and optimize it for effectiveness, meaning the degree of seizure control, and safety, meaning the lowest possible risk of teratogenicity;
• folic acid supplementation – folate supplementation should begin at least 3 months before conception and continue during pregnancy, as well as during postpartum and breastfeeding;
• measuring blood levels of antiepileptic drugs – the concentration of most new-generation antiepileptic drugs in serum can fluctuate during pregnancy, and reduced levels can contribute to increased seizures, so monitoring the concentration of selected drugs in blood before pregnancy and at least once in each trimester is recommended – your neurologist will decide whether and when such measurements should be taken;
• creating opportunities for information exchange between neurologist, gynecologist, and midwife – it's important to choose specialists experienced in caring for women with epilepsy and enable communication between them if necessary;
• implementing safety measures during pregnancy and postpartum period – epileptic seizures, both generalized and focal, can lead to accidental falls and injuries;
• ensuring proper preparation for childbirth, introducing specific habits into daily life will help minimize the risk of injuries in case of seizure;
• discussing possibilities and important principles of breastfeeding – breastfeeding is possible for most women with epilepsy, safety largely depends on the treatment used – discussing this topic with a neurologist during pregnancy will help you make decisions about how to feed your baby.

When to Plan Pregnancy

It's difficult to precisely determine the time needed to prepare for pregnancy – it looks completely different for each patient. We know, for example, that being seizure-free for 9 to 12 months before pregnancy gives over 70-90% chance of remaining seizure-free during pregnancy. Therefore, the earlier you discuss pregnancy with your neurologist, the more valuable preparation time you gain.

Project Pregnancy with CTP Neurosphera

At CTP Neurosphera, we treat women of all ages, implementing the highest standards of neurological care from the start. We also accept patients who want to come under our care during pregnancy preparation, pregnancy, and postpartum period. Each year, Neurosphera specialists treat many women planning motherhood, actively accompany them during pregnancy preparation, supervise the course of pregnancy, and support parents during the postpartum period.

Our specialist, neurologist Maja Kopytek-Beuzen, places particular emphasis on promoting knowledge about epilepsy among women, organizing free educational activities and running an information profile on FB aimed specifically at such patients: https://www.facebook.com/KobiecosciPadaczka.

Remember to discuss pregnancy and motherhood with your neurologist as early as possible!

Author: Dr. Maja Kopytek-Beuzen