The recent Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study shows that, with planning, people with epilepsy can have safe pregnancies and deliver healthy babies. If you are considering pregnancy, start working with your epilepsy care team as much as a year before trying to conceive to address issues related to your epilepsy, including getting seizures under control and, if necessary, switching to anti-seizure medications (ASMs) less likely to impact your baby’s development.

During pregnancy, most people with epilepsy will not have any change in the number of seizures they experience. If you have not had any seizures in the 9 months before your pregnancy, you are unlikely to have any seizures during your pregnancy. Work with your care team to adjust or change your anti-seizure medications (ASMs) to reach your best seizure control before trying to get pregnant.

About one-third of people with epilepsy do not experience complete seizure control with medications. This is called drug-resistant epilepsy. If these cases, the goal is to prevent seizures from being more frequent or severe during pregnancy.

It is essential to maintain seizure control because seizures during pregnancy can result in injury and an increased likelihood of complications. The likelihood of complications occurring is associated with the seizure type and frequency. Focal seizures do not carry as much risk as generalized seizures (but focal seizures can become generalized). Generalized seizures (especially tonic-clonic ones) carry more risk for both mother and baby.

How to safely manage risks of epilepsy and pregnancy

There are several things you can do to maintain seizure control during pregnancy and reduce risks:

Remember to Take Medication

Keep taking anti-seizure medications (ASMs) as prescribed throughout your entire pregnancy. This will help maintain the health of you and your baby.

Find medication tools for remembering to take your medication, managing daily activities, and more.

Monthly Check-ins

Plan with your epilepsy care team to schedule monthly level-checks of your ASMs and adjust doses when necessary. Most ASMs will need to increase doses during pregnancy to maintain the pre-pregnancy baseline levels. Even though you are increasing the dose, you and your baby’s exposure to your medication remains at the same level as before pregnancy.

Download the appointment calendar to keep track of medications during pregnancy.

Prioritize Sleep

Lack of sleep is a common seizure trigger for many people whether they are pregnant or not. Work with your care team to create a consistent sleep plan. Ask for support from your partner, family, friends, and even your employer to help carry out this plan.

Track Your Seizures

Keep track of your seizure activity. Share this frequently with your pregnancy and epilepsy care teams. Even minor seizure symptoms may signal that your chances of having a convulsive seizure are increasing.

If you don’t know the level of the anti-seizure medication in your system before pregnancy, ask your doctor to test your level. Do this as soon as you can once you find out you are pregnant. The level you’ll want to maintain throughout pregnancy should be this level or above. Your doctor should check your ASM levels by having your blood drawn every four weeks. Most ASMs will need to have dose increases during pregnancy to maintain the pre-pregnancy baseline level.

More frequent monitoring and adjustment of your ASM dose can help maintain your seizure stability while ensuring the safety and health of both you and your baby. Visits with your obstetrician (OB) are every four weeks (visits increase in frequency later in pregnancy). As a result, this is a good time to check your drug levels. Keep in mind that for the best comparisons of the blood levels, it is ideal to have your blood drawn at similar times of the day and similar lengths of time since your prior dose.

The possibility of a child developing cognitive issues (thinking, reasoning, remembering, learning words, using language, etc.) or behavioral issues varies. This may occur if their parent takes ASMs while pregnant and depends on the ASM.

Several ASMs have been found to pose low risk to babies. Studies suggest that lamotrigine and levetiracetam have the lowest chances of affecting a child’s IQ and other brain functions. Research also suggests that carbamazepine is generally low risk, while the data available on topiramate is mixed but suggests an increased likelihood of cognitive or behavioral issues in the child.

However, research has shown that children exposed to valproic acid during pregnancy, even at low doses, have a greater chance of having lower IQ and lower verbal abilities. They also have an increased risk of autism and autism spectrum disorder when compared to children not exposed to the drug. These effects continue into the child’s school-age years. If you take valproic acid, consult with your doctor to see if switching ASMs prior to becoming pregnant could be right for you.

There is limited information available on other ASMs. More research is needed to figure out how taking these medications during pregnancy affects the brain development of children. Talk to your doctor about what impact the ASM you take has on a baby’s brain development. If necessary, plan to possibly switch your medication before becoming pregnant.

You may hear doctors talking about major congenital malformations (MCMs), also known as birth defects. The term MCM is used to describe any differences from what’s considered a baby’s normal physical development. MCMs include conditions such as spina bifida, heart problems, and cleft lip/palate. All pregnancies, whether the parent has epilepsy or not, carry a 2-3% risk of MCMs.

The risk of developing MCMs varies significantly by ASM. Lamotrigine, levetiracetam, and oxcarbazepine show the lowest risk of contributing to the development of an MCM during pregnancy. In fact, recent research found that babies exposed to these three ASMs showed no higher risk of fetal malformations than babies born to people who did not take any ASMs during pregnancy.

Exposure to topiramate and carbamazepine during pregnancy has been found to moderately increase the risk of the baby being born with an MCM. Valproic acid is linked to the highest risk. Currently, there is limited data available on other ASMs related to MCM risks.

Some ASMs can also affect the size of your baby. Babies born to parents taking topiramate might have a lower birth weight, which can carry some long-term health risks. Zonisamide may also have this effect but to a less severe degree. If you need to take these medications while pregnant, your doctor may want to closely monitor your baby’s growth.

Authored By:

Naymee J Velez Ruiz, MD FAES

on Sunday, November 05, 2023


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