Suzie is a 23-year-old who arrived at the hospital last week by ambulance after having a seizure at home. She is 16 weeks pregnant with her first baby. Suzie was diagnosed with epilepsy when she was 10 years old and has been on anti-seizure medications since that time. She had not seen her neurologist in more than a year. Until last week, she had not had any seizures for a long time, about 3 years.
Problems with seizures during pregnancy
About a million women in the US who are in their reproductive years have some kind of seizure disorder. And when they become pregnant, they have a unique set of potential problems.
- Birth defects – There is a higher risk of birth defects in children of mothers with seizure disorders. We don’t know whether this increased risk is related to the seizure disorder itself, or the medications we use to treat them. We do know that when a seizure happens, blood flow to mom and baby is reduced, and this is never good. And some seizure medications are known to increase the risk of certain fetal anomalies, especially spine defects, cleft lip and palate, and heart defects.
- Lower levels of seizure medications in the blood – Even if you’re taking your medicine exactly as instructed, there may be a lower level of seizure medication circulating in your blood. This happens because some drugs are more tightly bound to proteins during pregnancy, and there are less free drugs available to keep you from having seizures. So drug doses may need to be increased in pregnancy, in order to keep from having seizures. Remember our patient Suzie? Her medication level was low because she stopped taking her medication when she became pregnant. She did this because she was worried about the risk to her fetus. This happens more often than I can tell you. We explained to Suzie that, although some seizure medications are associated with a risk to the fetus, the bigger risk occurs when moms have seizures. Keep reading.
- Seizures – When pregnant moms have uncontrolled seizures, there is a higher chance of placental separation (abruption), stillbirth, prematurity, and low birth weight. Not to mention that having seizures is just plain bad for you.
Figuring out medications before pregnancy
If you are lucky enough to be thinking about your seizure disorder before you become pregnant, visit your neurologist and let them know about your plans.
It’s possible that they may want to switch to another medication that may be considered safer in pregnancy. The time to experiment with medications is before getting pregnant, not during pregnancy. You may also be placed on supplemental folic acid for a few months before attempting pregnancy. Folic acid helps reduce the risk of many birth defects, and folic acid levels may be reduced by some seizure medications.
You should also be aware that there is an increased risk of unintended pregnancy in women who take seizure medications and birth control pills.
This happens because seizure medications can lower the level of oral contraceptive in your blood.
Breastfeeding with a seizure disorder
Wondering about breastfeeding if you have a seizure disorder? No worries. Most women with well-controlled seizures are able to breastfeed their babies. The key word is well-controlled. If your seizures are not well-controlled, you will have to be very careful when caring for your baby. You should have someone with you at all times – when carrying the baby, changing diapers, and bathing the baby. If you are alone with the baby and have a seizure during any of these activities, the results can be disastrous.
With all that said, the majority of women with seizure disorders can have successful pregnancies. If you are taking seizure medication, keep taking your medication, and schedule visits with your OB provider and your neurologist as soon as possible. If you don’t have a neurologist, your OB can help you find one.