FACT: 90 percent of moms-to-be who have epilepsy will have a healthy pregnancy.
The good news for pregnant women with epilepsy is very good: While seizure disorders affect about 1 million women and girls, more than 90 percent of moms-to-be with this disease have healthy babies, according to the Epilepsy Foundation. As with other chronic conditions, working closely with your doctor to manage your condition is key, says Marianna V. Spanaki, MD, PhD, senior staff neurologist at Henry Ford Hospital and an associate professor at Wayne State University, in Detroit.
During pregnancy, your body goes through so many changes -- including your weight and the way your kidneys metabolize drugs. Your kidneys may remove antiepileptic drugs (AED) from your system more quickly than usual -- the levels could drop to 50 percent of what they were prepregnancy, say Dr. Spanaki. That means making monthly visits to your neurologist for blood tests to ensure you're on adequate dosages. Your doctor will aim to put you on the lowest effective dose and to use just one drug if possible. He'll also check to see that you're getting adequate levels of folic acid -- Dr. Spanaki recommends at least 800 micrograms daily -- very early in pregnancy, because epileptic women are at an increased risk of having a baby with neural tube defects.
Women with epilepsy are also at greater risk for morning sickness, vaginal bleeding, placental abruption (in which the placenta detaches from the uterine wall), preterm labor, and bleeding problems in the baby following delivery. The best way to ensure an uneventful pregnancy is to take your antiseizure medication exactly as your doctor has instructed. "Some people think that if they don't take their medication, they will eliminate problems with the baby, but this isn't true," Dr. Spanaki stresses. "They shouldn't stop their medication or drop their dose."
As with asthma, about one-third of women will have more seizures, one-third will have the same number, and the other one-third will have fewer. Dr. Spanaki says women who had infrequent or no recent seizures prior to conception and who take their medicine as prescribed are most likely to get through pregnancy without a seizure. However, the unhappy truth is that following the rules does not always protect your child from birth defects. The general risk for having a baby with birth defects is two to three percent; for women on AED, it's six percent.
Seizures pose their own potential risks to both you and your child. "If a woman falls during a seizure, she may injure herself and the baby," says Dr. Spanaki. (These grand mal seizures, characterized by loss of consciousness, falling down, or a loss of bowel and bladder control, present the greatest risks.) "They also compromise the blood flow to the baby," she explains. "You may also have preterm labor, in which case we may be concerned about the cognitive development and birth weight of the baby." Less serious, "partial" seizures during pregnancy haven't been studied.
Besides sticking to a well-monitored AED regimen, a woman should make getting enough sleep a top priority. Sleep deprivation can bring on seizures, says Dr. Spanaki, who stresses frequent naps and a good night's sleep "at any cost." A balanced diet is also important, and if morning sickness is causing vomiting that may impair absorption of your medication, talk to your doctor.
When it comes time for labor and delivery, you can rest a little easier: Seizures seldom occur during childbirth. "Although this is one of their biggest fears, women don't seem to have many seizures at this time," says Dr. Spanaki.