Years ago, women who had epilepsy were often discouraged from getting pregnant. Thanks to early and regular prenatal care. However, don't panic if you have a seizure while you're pregnant. Remember, there are many normal, healthy babies born to women who had seizures during their pregnancy.

Does epilepsy make it more difficult to conceive?

Occasionally seizures may disrupt the signals in the brain and can have negative impact on ovaries when to release an egg. This can affect your menstrual cycle and fertility. Medication may be an issue as well. Some drugs used to treat seizures can affect fertility.

How epilepsy does affect pregnancy?

Epileptic women have higher risk of pregnancy related complications

• Vaginal bleeding
• Premature separation of placenta from the uterus

• Premature births

• High blood pressure

How can pregnancy affect seizures?

• Every woman reacts to pregnancy differently.
• For most pregnant women who have epilepsy, seizures remain the same.
• One quarter to one third of women with epilepsy who become pregnant will have increased seizures during their pregnancy despite continued use of antiepileptic medication.
• During pregnancy, concentrations of seizure medication in the bloodstream may change or decrease, putting you at greater risk for seizures.

• For others, pregnancy makes seizures worse particularly during the first trimester.

• The first two months after delivery are another time when your hormones and your body chemistry may change, affecting levels of your seizure medication.

Do seizures in pregnancy harm the Fetus/baby?

• Although many mothers who have seizures also have perfectly normal babies, seizures during pregnancy can harm the baby.
• Generalized tonic clonic (grand mal) seizures can cause miscarriages, although this is a very very rare occurrence.
• Generalized tonic clonic seizures during the last month of pregnancy can cause injury to the baby.
• If they occur during labor, they reduce fetal heart rate, which can indicate that the baby is in distress.
• Generalized tonic clonic seizures during pregnancy have not been associated with birth defects.

• For babies whose mothers take seizure medication, the risk of birth defects is 4 percent to 8 percent — compared with 2 percent to 3 percent for all babies, the risk seems to be highest when multiple seizure medications are taken.

• Babies born to mothers who have epilepsy have a slightly higher risk of developing seizures as they get older. Developmental and growth delays are possible as well.

Should anti-epileptic medications stopped before planning pregnancy?

This is a complicated decision.

• Pregnancy without antiepileptic medication might lessen some of the possible risks to the baby.
• If a woman has been seizure-free for many years, it may be possible for her and the physician to slowly discontinue medication before she attempts to become pregnant.
• Remember, you should never stop your seizure medication without the advice and supervision of your doctor.
• For most women with epilepsy, staying on medication poses less risk to their own health and the health of their babies than discontinuing medication.
• In most cases, a single medication at the lowest possible dose that provides seizure control is the best option.

Is cesarean section indicated in all epileptic pregnancies?

• Simply having epilepsy is not a reason for having a cesarean section.
• Most mothers with epilepsy are able to deliver their babies normally.
• A cesarean section will be performed by obstetrician only if it is necessary for your baby's safety.

Anti epileptic medications

Drug of choice in pregnancy is Phenobarbitone.

Most of the fetal anomalies are due to Phenytoin, Valproate, and Carbamazepine etc

Common side effects include

• Neural tube defects
• Low set ears
• Epicanthal folds, hypertelorism, ptosis
• Short nose
• Developmental delay
• Microcephaly
• IUGR

Preconceptual management of women with epilepsy

• Women with epilepsy should avoid taking more than one epilepsy drug at a time during pregnancy, as doing so raises the risk of birth defects compared with taking only one medication.
• To taper dosages of antiepileptic drugs to the lowest possible dose
• In women who have not had a seizure for 3-5 years, attempt complete withdrawal of medications can be given a trail
• Establish the level of total and free antiepileptics necessary for achieving good clinical control.
• Consider preconceptual genetic counseling.

• Supplement the diet with folate at 4 mg/d.

• Smoking during pregnancy may increase substantially the risk of premature contractions and premature labor and delivery during pregnancy.

Management of epilepsy during pregnancy

• Check total and free levels of antiepileptics drug levels monthly.
• Consider early genetic counseling.
• Check maternal MSAFP levels and perform a level II fetal survey and ultrasonography at 19-20 weeks' gestation.
• Consider amniocentesis for alpha-fetoprotein and acetyl cholinesterase.