What is a seizure disorder?
A seizure is an abnormal sudden surge in electrical activity in the brain. This causes changes in how the person appears or acts for a short time, which can include changes in mood, movement, emotions, or consciousness. A seizure disorder is also referred to as epilepsy.
For most women with a seizure disorder, pregnancy will not increase how often seizures occur. However, 15 to 30 percent of women will have an increase in seizure frequency.
How common is a seizure disorder during pregnancy?
Seizure disorders are not very common in pregnancy. They affect 0.3 to 0.7% of all pregnancies with an estimated 22,000 babies born to moms with a seizure disorder each year.
How is a seizure disorder during pregnancy diagnosed?
The majority of women with a seizure disorder will be diagnosed before they get pregnant. If you have your first seizure while you are pregnant, you will need to have an immediate evaluation for eclampsia, a severe form of high blood pressure during pregnancy. This includes taking your blood pressure, analysis of your urine, and blood work checking your blood counts and kidney function.
There are a number of medical conditions that can cause you to have a seizure besides a seizure disorder. Once eclampsia has been ruled out, a full evaluation looking for other causes of a seizure is usually done. This may include checking for infection, evaluating your electrolytes (sodium, potassium, etc.), performing an electrocardiogram (ECG) to look for heart problems and an electroencephalography (EEG) which looks at your brain waves. You may also need an MRI or CT of the brain, which are both safe to do in pregnancy if they are needed.
If this evaluation is normal, then a neurologist will decide if you have developed a seizure disorder. They will also decide if you need to start treatment and which medication should be used.
Does a seizure disorder cause problems during pregnancy?
Yes, a seizure disorder can cause problems in pregnancy but it is important to know that 90% of moms will have a normal pregnancy. Some of the problems seen during pregnancy include:
- Preterm labor labor before 37 weeks
- Placental abruption separation of the placenta before the baby is born, which may cause life-threatening bleeding for mom and baby
- Mild preeclampsia high blood pressure problem of pregnancy
- Bleeding late in pregnancy
- Slightly higher risk for maternal death this appears to be related to the seizure disorder and not the pregnancy
These problems occur more often if you are taking medication to treat your seizure disorder. However, it isnt known if this is because of the medication or because the seizure disorder is more severe.
Does a seizure disorder during pregnancy cause problems for the baby?
Yes, a seizure disorder can cause problems for the baby but it is important to know that 90% of pregnancies will result in the delivery of a healthy baby. There is a 6 to 8% risk that the baby will have a birth defect. The most common types of birth defects are:
- Cleft lip or palate abnormal opening in the upper lip or roof of the mouth
- Heart defect
- Neural tube defect abnormal development of the spinal cord or brain
These risks appear to be caused by the medications used to treat the seizure disorder. However, simply stopping these medications to avoid these risks isnt a good option because there are also risks if you have a seizure during pregnancy. Seizures can cause injury to the developing baby, early separation of the placenta causing the baby to die, or miscarriage. If your seizures cause you to lose consciousness, it can result in decreased oxygen to the baby causing damage to the developing brain. Seizure medications help to prevent these complications from occurring, as well as preventing injury to you.
One thing that can be done to prevent your baby from having a neural tube defect is to take 4mg of folic acid (a B vitamin). You should start taking this 3 months before you get pregnant for it to be most effective, but if you did not start taking it before you got pregnant, you can still start taking it as soon as you find out you are pregnant.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the seizure disorder.
- The risk of seizures returning if you stop taking your medication or if you switch to a different medication.
- The risks and benefits of each medication you use when you are pregnant.
- The risks and benefits of each medication you use when you are breastfeeding.
What should I know about using medication to treat a seizure disorder during pregnancy?
The best thing that you can do to limit the risks from seizure medications is to see your health care provider before you get pregnant. This is the best time to decide if a different medication would be safer to take while you are pregnant, if you can take fewer medications, or if your medication dose can be decreased. It is recommended to make medication changes before you get pregnant because the highest risk from seizure medications is during the first seven weeks of pregnancy, the time when most women dont realize they are pregnant. So by the time you have your first prenatal visit, the opportunity to change a seizure medication to reduce the risk to the developing baby will have passed. Because of this once you are pregnant your regular seizure medications will be continued.
Who should NOT stop taking medication for a seizure disorder during pregnancy?
Because there are significant risks associated with having a seizure while you are pregnant, it is never recommended to stop taking your seizure medication. Since the risk of harming the pregnancy or baby from taking a medication is small, it is generally recommended to continue taking your seizure medication while you are pregnant.
Talk with your health care provider before you get pregnant to see if any changes can safely be made to your seizure medications to reduce your risk of pregnancy complications.
What should I know about choosing a medication for my seizure disorder during pregnancy?
Some of the medications used to treat seizure disorders can cause birth defects. The most common birth defects include heart, urinary tract, musculoskeletal, and neural tube defects, as well as cleft palate. Certain medications have also been linked to autism and learning problems. In general, it is recommended to avoid taking valproate while pregnant because it has the most risk associated with it. Beyond this recommendation, there is not enough information at this time to recommend one medication as safer than another. In general, babies exposed to more than one medication and to higher doses of medications are at higher risk of developing a birth defect. If it is possible, reducing treatment to just one medication and using the lowest effective dose is the safest option.
You may find Pregistrys expert reports about the individual medications used to treat seizure disorder here. Additional informat
ion can also be found in the sources listed at the end of this report.
What should I know about taking a medication for my a seizure disorder when I am breastfeeding?
Breastfeeding is encouraged, even if you have a seizure disorder. Most of the medications used to treat seizures are safe to use while nursing. If you are using phenobarbital it may cause excessive drowsiness in the baby and lead to withdrawal symptoms when you stop nursing. If you are taking this medication and cant change to another medication, your pediatrician can help you decide if breastfeeding is safe for you and your baby.
What alternative therapies besides medications can I use to treat my seizure disorder during pregnancy?
There are no alternative therapies that can be used to treat a seizure disorder. Sleep deprivation in people with a seizure disorder can trigger seizures, so it is important to sleep regularly and to get enough sleep while you are pregnant.
What can I do for myself and my baby when I have a seizure disorder during pregnancy?
Seeing your health care provider prior to getting pregnant is the best thing you can do to reduce your risks while you are pregnant. Taking your medications as prescribed and having your medication levels checked regularly during pregnancy are also important.
Talk with your health care provider early in pregnancy about screening options that are available to check your baby for any possible birth defects. These generally include a blood test called the serum-alpha-fetoprotein, which screens for neural tube defects and a detailed ultrasound between 18 and 20 gestational weeks.
It is also important to get enough rest and take your prenatal vitamin with extra folic acid regularly.
Resources for a seizure disorder during pregnancy:
For more information about a seizure disorder during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following links:
- Epilepsy Foundation Epilepsy and Pregnancy
- National Institute of Neurological Disorders and Stroke Epilepsy
- American Epilepsy Society