Patty Shafer, RN, MN
Epilepsy.com Resource Specialist
Results of many pregnancy registries of women taking seizure medicines have suggested greater risks for babies born to women taking valproic acid, both in terms of major birth defects and developmental problems. The latest study discussed by Dr. Sirven suggests that women who have one or more children with a major birth defect while taking seizure medicines, especially valproic acid, have a greater risk of having another child with a birth defect. So what does this mean for the woman with epilepsy planning to have children?
Are seizure medicines dangerous to take during pregnancy? While some seizure medicines have a greater risk of birth defects in babies born to mothers on these medicines, this doesn’t happen with all seizure medicines. Also, it’s important to put the risks into perspective. 2 to 4 % of all women may have a child with a major birth defect. This risk has been found to be higher in women taking valproic acid or valproate, and to a lesser extent phenobarbital . Developmental problems in babies born to women taking seizure medicines during pregnancy are also greater in the first 4.5 years of the child’s life for those exposed to valproic acid.
While taking any of these medicines may pose a risk for the unborn child, NOT taking seizure medicine that is needed to control seizures poses a greater risk. . It’s critical that people realize that having seizures during pregnancy can place both the woman and her unborn child at risk of pregnancy complications and life-threatening harm.
What type of doctors should I see during pregnancy? It is probably best for all women who have epilepsy and are taking seizure medicine to be seen by an epilepsy specialist and high-risk obstetrician to learn about their risks and how the pregnancy should be managed. If the woman has well-controlled epilepsy and is not taking a seizure medicine that can increase the chance of major birth defects, then the pregnancy may not require high risk obstetrical care at all times.
If a woman continues to have seizures and is taking seizure medicine with risks of birth defects, continuing follow-up with an epilepsy and high risk obstetrical team is wise.
What can I do before becoming pregnant to lessen my risks? Getting in the best health possible is the first step a woman can do to improve her chances of having a healthy child and uneventful pregnancy. Some examples of this may include:
See your primary care doctor and gynecologist to see if you are in good health and ready for pregnancy. If other health issues are found, tackle these first to get them under control.
See your epilepsy doctor BEFORE you become pregnant. Make a specific appointment to do this as part of family planning.
Ask what other tests may be needed for your epilepsy. Is your diagnosis known? Is testing still needed to sort out what type of seizures you have? Knowing the type may help choose the best medicine to control the seizures.
Keep track of your seizures and be honest with your doctor and other health care providers about how often you have seizures.
If you are still having seizures, review your medicine history with your doctor and consider making changes to improve seizure control BEFORE you become pregnant.
Make an appointment with a high-risk obstetrician for their opinion on pregnancy. You can then consider who would be best for you to follow-up with during and after the pregnancy.
Depending on the kind of epilepsy you have and other family history information, consider a consult with a geneticist and genetic counselor. We are learning more about some types of epilepsy with genetic links that may be helpful to know ahead of time. However, keep in mind that genetic links to most epilepsies are not known at this time.
Get started on the appropriate vitamins that the obstetrician and epilepsy doctor will recommend. This would include Prenatal vitamins and Folic acid supplements.
Meet with a nurse, ideally one involved with epilepsy or high risk pregnancies, to learn about the practical aspects of managing pregnancy and the postpartum period. This can be invaluable in planning when to move forward.
Living with epilepsy can be difficult, and so too can the added challenges of being a parent with epilepsy. Talking to a counselor can be very helpful in exploring your feelings and readiness to be a parent and cope with the challenges and blessings you may face.
Start putting together your team early, collect information that will help you and your family make the decisions that are best for you, and remember, the overwhelming majority of women with epilepsy have healthy children!
Best wishes for a safe week!
by Patricia Osborne Shafer RN, MN
Resource Specialist, epilepsy.com
Last Reviewed: 10/3/2012
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