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Pregnancy Planning

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1 Pregnancy Planning on Thu Oct 01, 2009 9:01 am

TJW

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Planning a baby

The majority of women with epilepsy have healthy pregnancies and give birth to healthy children. Wherever possible, it is advisable for every pregnancy to be planned, because for women with epilepsy, there is a slightly higher risk of complications than in women who don’t have epilepsy. However, with forward planning, these risks may be minimised.

Folic acid

Many doctors suggest that if you are a woman of childbearing age with epilepsy, you should take folic acid supplements of five milligrams a day. You should start these before you get pregnant and carry on taking them during the first three months of pregnancy. Some doctors suggest that ideally, you should take five milligrams of folic acid daily all the time, as accidental pregnancies are common.

Folic acid may interact with the anti-epileptic drugs phenytoin, phenobarbital and primidone, making them less effective. For this reason, if you are taking any of these anti-epileptic drugs, it is important to seek advice from your doctor before taking folic acid supplements.
Risks during pregnancy, associated with epilepsy and anti-epileptic drugs.

In 1996, the UK Epilepsy and Pregnancy Register was set up to find out more about the risks associated with epilepsy and anti-epileptic drugs during pregnancy. Their website is Here

The results from a study of 3,607 women with epilepsy who were monitored through this register during pregnancy, whether or not they were taking AEDs, were published in a report in September 2005. The information that follows is taken from this report, because it is the most up-to-date and comprehensive information that is available at the time of writing.

The risk of AEDs affecting your unborn child appears to be greatest during the first three months of pregnancy. This is why it is advisable to speak to your doctor and get your medication reviewed before you become pregnant, if possible.

Major congenital malformations

Some of the problems that may occur in babies who are born to mothers with epilepsy are classed as major congenital malformations (MCMs).
Congenital means a condition that is present at birth. MCMs include abnormalities such as malformations of the spinal cord and spine (spina bifida), the heart (such as hole in the heart), the ribs, the bladder, the sexual organs and the fingers and toes (such as unseparated fingers).
The risks of MCMs can be related to having epilepsy itself and to any AEDs that a woman is taking during pregnancy.

Women in the general population have a one to two per cent chance of having a baby with a MCM (one to two children in every 100 born).
Women with epilepsy, who do not take AEDs, have a three and a half per cent chance of having a baby with a MCM.
Women who do take AEDs have an average of around a four per cent chance of having a baby with a MCM.

The risk of MCMs also depends on the number of drugs that the woman is taking during pregnancy.
In women who take only one AED, the average MCM rate is slightly more than three and a half per cent.
In women who take two or more AEDs, the average risk is increased to six per cent.

Risks of major congenital malformations related to specific anti-epileptic drugs

Carbamazepine taken as a single drug treatment (known as monotherapy) carries the lowest risk, with 2.2 babies born with MCMs in 100 women taking the drug (2.2 per cent)
Taking sodium valproate as monotherapy at a daily dosage under 1000mg, carries a risk of 5.1 in 100 (5.1 per cent)
Taking sodium valproate as monotherapy at daily doses over 1000mg carries a risk of 9.1 in 100 (9.1 per cent)
Drug combinations that include sodium valproate have a significantly higher risk of MCMs than combinations that do not include this drug.
Taking lamotrigine as monotherapy at daily dosages of 200 mg or less carries a risk of 3.2 in 100 (3.2 per cent)
Taking lamotrigine as monotherapy at a daily dosage above 200 mg carries a risk of 5.4 in 100 (5.4 per cent)
Taking carbamazepine and sodium valproate together carries a risk of 8.8 in 100 (8.8 per cent)
Taking sodium valproate and lamotrigine together carries a risk of 9.6 in 100 (9.6 per cent)

The information from the study did not include any specific data on vigabatrin, gabapentin, topiramate, tiagabine, oxcarbazepine, levetiracetam and pregabalin.

Minor congenital abnormalities

Women with epilepsy are also at an increased risk of having a baby with less severe problems, which are classed as minor congenital abnormalities. These include small fingers and toes with small nails, clubfoot and facial abnormalities. At the time of writing, there are no percentages for the risks of minor congenital abnormalities available, and more research into this is needed.

There is some evidence to show that having epilepsy slightly reduces a woman’s fertility. However, this effect is usually treatable. Having epilepsy and taking anti-epileptic drugs does not prevent a woman from receiving fertility treatment. A few women may experience a small increase in the number of seizures when taking certain hormone-based fertility drugs.

Pre-conception counselling

If you have epilepsy and are considering having a baby, it is a good idea to seek advice, known as pre-conception counselling, before you get pregnant. Pre-conception counselling provides an opportunity to discuss your epilepsy and medication with a health professional with an interest in epilepsy, usually an epilepsy specialist or an epilepsy specialist nurse. (For more information, see the section Risks of taking anti-epileptic drugs in pregnancy.)

During pre-conception counselling, you will be able to discuss how your epilepsy may affect your pregnancy. It is also an opportunity to consider the risks that your anti-epileptic drugs (AEDs) or uncontrolled seizures may pose to your baby.
In all pregnancies there is a small risk that the mother may die. Each year in the UK, about four women with epilepsy die during pregnancy. This risk is seven times higher than for women without epilepsy. The health professionals involved in studying maternal deaths, believe that the increase in risk may be due in part to women not taking their AEDs as prescribed during pregnancy.

Not taking AEDs can lead to uncontrolled seizures, which increases the risk of sudden unexpected death in epilepsy (SUDEP).
For this reason, during pre-conception counselling, your health professional will try to help you have good seizure control with AEDs that pose the lowest risks to the baby. After considering all the risk factors, your health professional may suggest that you change the amount of AEDs you take.

They may advise a change to a different AED or even stop taking AEDs altogether, before you get pregnant. The majority of women with epilepsy have healthy pregnancies and give birth to healthy babies. The advice you will be given will depend on your own circumstances.
The risk of AEDs affecting your unborn child is at its greatest during the first three months of pregnancy. This is why it is advisable to have a review of your epilepsy and medication before you become pregnant.

If you become pregnant before you have had any pre-conception counselling, it is important to continue taking your AEDs as usual. Don’t make any changes until you have had an opportunity to talk to your epilepsy specialist or epilepsy specialist nurse. If you stop taking your AEDs, it could cause you to have an increase in seizures, or your seizures may become more severe. This may cause more problems for you and your unborn baby than any risks associated with the drugs themselves.

It is advisable to make an appointment to see your family doctor, epilepsy specialist or epilepsy specialist nurse as soon as you find out that you are pregnant.

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