Epilepsy and Pregnancy - The risks to be aware of and protecting your baby

Epilepsy is one of the most common neurological disorders in pregnant woman and without appropriate medical treatment can be responsible for maternal and fetal mortalities.

Epilepsy is a condition whereby nerve cells (neurons) are stimulated in an abnormal way resulting in fits or strange sensations that do not actually exist. The goal in caring for pregnant women with epilepsy is to keep her free of seizures and minimise the effect of the epilpesy on the unborn baby. During a seizure the women may fall and injure herself and her baby, and may suffer from hypoxia (lack of oxygen) which may affect the fetus.

Pregnancy results in changes to a woman's body. Morning sickness (vomitting) may have an impact on the levels of anti-epileptic drugs in the woman's body. Stress and hormones caused by the pregnancy may increase the risk of seizures.

Many epilepsy drugs are thought to damage the fetus if taken during the early stages of pregancy. However, the effect of stopping medication can increase the risk of seizures which too can be potneitally harmful to the babay. It is therefore essential the pregnancy is monitored carefully to monitor the effects of the medication. An early scan at 18-20 weeks should normally be undertaken to check on the fetal development.

Statistics show during pregnancy many women with epilepsy will have a trouble free pregnancy. However around 40% will develop an increase in seizures. One of the reasons for this is thought to be the change in circulatory levels which will affect the amount of drugs in the blood stream. With carefull monitoring this risk can be controlled.

Labour is a time of increased stress, pain and dehydration - all of which are factors that increase the risk to a seizure. It is therefore important that appropriate care is given. Antiepileptic medication may be given during the labour and the medics present should be vigilant as to the signs of an impending seizure.

A total of 4-8% of women with epilepsy who are on epileptic medictaion will have a congenital anomaly. This is 2-3 times higher than the general population. Vitamin K levels are thought to be lower in babies born by women with epilepsy. Vitamin K is usually therefore administered to the mother from 36 weeks and to the baby at birth.

With careful monitoring by experienced doctors and midwives a mother with epilepsy can have a problem free pregnancy and labour. A multi-disciplinary approach should be taken so apporpriate advice can be given throughout.

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