Epilepsy and pregnancy – Top expert on risks of seizures and medications (9)

By Paul Henry / in , , , , , , , , , , , , , , , , , , , , , , , , /

– Epilepsy and pregnancy.
Dr. Anton Titov MD What are the nuances of treating epilepsy
during pregnancy? What are the major risks for mother and for
a child – because of the seizures, or risk of seizures, and also because of the side
effects of the drugs? Yes, epilepsy and pregnancy is a very important
topic. And I always like to start by emphasizing
that women with epilepsy, the vast majority of them have wonderful pregnancies and beautiful
healthy babies. That’s something that not everybody knows. Sometimes people think that women with epilepsy
can’t have children, shouldn’t have children or will have problems. And that is not the case in over 90% of pregnancies. It’s very important that a woman with epilepsy
work with a doctor to get good seizure control before pregnancy, because how well the seizures
are controlled before pregnancy predicts how well they’ll be controlled during pregnancy. The body’s metabolism really changes quite
a bit during pregnancy, and so we want to know what the drug level is? What is the amount of medication in the bloodstream
prior to the pregnancy, and we work to keep that medication at the same level. I also want to emphasize how important it
is to take anti-seizure medicines during pregnancy. That’s so important, and so many women are
afraid the medicine will hurt the baby and they stop the medicine and that causes problems
for the mother and for the baby. In women with epilepsy, they should continue
to take medicine all through pregnancy to control the seizures. Seizures are worse for the baby than the medicine. Now, there are some medicines that we think
are relatively safe during pregnancy, and others, like Divalproex Sodium that we know
are harmful to the baby. The medicines that we try to avoid in a woman
who could become pregnant are a divalproex sodium, phenobarbital and topiramate. And those three medications we know have a
higher risk of birth defects. Some of the newer medicines seem to be fairly
safe, and we have good studies that show that those seem to be fairly safe during pregnancy. But the bottom line is: a woman who is thinking
about becoming pregnant should talk to their doctor about the medicine that they’re taking. And even in a woman who’s not thinking about
being pregnant, their doctor should talk to them, because many pregnancies are not planned. Because of that we also recommend that all
women with epilepsy who could become pregnant take folic acid. Folic acid or folate, that’s the other name
for it, is a vitamin that is known to reduce the risk of birth defects. And so in the United States, for example,
we started adding folate to our grain products and there was a dramatic drop in neural tube
defects among all women in the United States. In women with epilepsy who might have a greater
risk of having a lower level of folic acid, we recommend they take one milligram every
day. Even if they’re not planning to become pregnant. Because many pregnancies are unplanned and
by the time the woman is aware that she’s pregnant, the neural tube has already formed,
what will become the spinal cord and the brain. When women are pregnant, we will make sure
that the drug level stays the same in their system. That usually requires increasing the dose
of medication. The dose of medication, the number of pills
a woman takes during pregnancy may increase quite a bit. But that medication level in the blood will
stay steady, it just requires more pills to keep that level steady. We also encourage women after they’ve given
birth, to breastfeed their infants. We know that breastfeeding has a number of
benefits and that those benefits outweigh the risk of the medication in the breast milk. Most women, as I mentioned, have very healthy
pregnancies and give birth to healthy babies. But there is a little bit of an increased
risk in women with epilepsy. Because we do know that there’s an increased
risk during childbirth, and so it’s important, when women can, to seek the care of a trained
obstetrician and have an obstetrician involved in the childbirth. Is there a particular reason to have a cesarean
section delivery in a woman who is pregnant and has history of epilepsy? There is no reason for a woman with epilepsy
to have a cesarean section simply because she has epilepsy. But rather there is a need for increased monitoring
and an awareness that there could be more complications during the delivery. So having a trained physician present and
ready to perform a Cesarean section operation, if it’s necessary. But it’s not because the woman has epilepsy.

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