LIVING WITH EPILEPSY: RISKS OF PREGNANCY AND OF ANTICONVULSANT DRUGS
Although pregnancy might affect your seizures, your risks during pregnancy are little different from the risks other women face. If you have questions about conditions that might have caused your epilepsy or about the effect of pregnancy on other health problems, you should check with your physician before you decide to become pregnant.
Your seizures may change during pregnancy. Therefore, your obstetrician needs to know about your epilepsy and your neurologist about your pregnancy. In about one-third of pregnant women, seizures get worse, in one-third they improve, and in one-third they are unchanged. Since we cannot predict which group you will fall into, your pregnancy should be monitored carefully. Ideally you should be on the lowest amount of a drug, and on a single drug only, to control your seizures. This drug, and its level, should, if possible, be determined before you become pregnant. Anticonvulsants should not be changed during your pregnancy unless such a change is needed for seizure control or because of toxicity.
Since blood levels change as your body chemistry itself changes during the pregnancy, blood levels of your medications should be monitored. We generally recommend that these levels should be measured early in the pregnancy, then followed every month in the middle third of your pregnancy and every several weeks in the last trimester.
There are three principal reasons why seizures increase during pregnancy in almost one of three women with epilepsy. The first is that pregnant women are naturally fearful that taking drugs may affect the fetus and, therefore, may fail to take anticonvulsant medication according to schedule. A second reason is lack of sleep during pregnancy. A third cause of seizures during pregnancy is changes in the body’s metabolism of drugs. Although such changes can cause blood levels to rise and thus cause toxicity, blood levels can also decline, leading to seizures. Your physician should closely follow your blood levels and provide appropriate adjustments.
Although there is little evidence that brief seizures injure the fetus, a prolonged seizure might affect your fetus and any seizures might cause injury to you. Therefore, we strongly urge that pregnant women with epilepsy who need medication for seizure control continue to take the drug that has been controlling their seizures.
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