Epilepsy during pregnancy

If you have epilepsy and are expecting (or planning) a baby, it's important to know how to take care of yourself and your bump. Epilepsy expert, Nicole Crosby-McKenna answers all your questions…

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Will having seizures during pregnancy harm your unborn baby?

Very rarely. Most seizures would only affect your unborn baby if you are injured during a seizure, for example because they caused you to fall. However, in women who have frequent tonic-clonic seizures, there is a small risk to the baby. If a woman went into status epilepticus – which is a seizure or set of seizures, which lasts for twenty minutes or more – there is a real risk to the baby. This is because during status epilepticus the oxygen supply is compromised. To reduce the risk of having a seizure during pregnancy, the best thing is to plan, plan, plan.

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     “Research shows that the majority of women don’t have an increase in seizures during pregnancy, and those women who are seizure-free for 12 months before pregnancy are often then seizure-free during pregnancy,” says Nicole Crosby-McKenna, Development Officer for Women at Epilepsy Action.

Will anti-epilepsy medicine affect your growing baby?

“Around 96% of babies who are born from women with epilepsy who take anti-epilepsy drugs are born perfectly healthy,” says Nicole.

But there are slightly increased risks of malformations. To put this into context, every woman who gives birth has a 1-2% risk that their baby might be born with a major congenital malformation. If you take anti-epilepsy drugs, this risk increases to approximately 4%, so this is still a very small chance. However the risk depends on which anti-epileptic drug you are taking, because for example if you take lamotrigine or carbamazepine at a low dose, the risk of your baby having a malformation is around 2%, which is almost the same as if you didn’t have epilepsy.

Because of these risks, women are sometimes tempted not to take their medication during pregnancy. However this is not advised, because if you don’t take your epilepsy drugs you are increasing the risk of having seizures,which in turn increases the risk for mother and baby. Having frequent seizures, unfortunately increases the risk of status seizures and Sudden Unexpected Death in Epilepsy (SUDEP).  This risk of harm might be higher than the risk of harm had you taken your drugs for your seizures in the first place.

The most important thing is that when trying to conceive and during pregnancy mum is as healthy as she can be, as this in turn will mean that baby is as healthy as she or he can be.

If you are ever worried about your epilepsy during pregnancy, especially if you are having more or worsening seizures, speak to your doctor or epilepsy specialist straight away.

Will you need to have extra tests and scans?

No, having epilepsy doesn’t necessarily mean that you have to have extra tests and scans.

If you were to have seizures during your pregnancy, then you might be offered additional tests just to measure the level of anti-epileptic medicine in your blood. If it is decreasing and you are having more seizures, then they’ll increase your medication.

All mums are offered extra tests to check the baby is developing properly and to calculate the risk of their baby having spina bifida or Down’s syndrome for example.

If you are taking a high dose of anti-epilepsy medicine, or more than one, you might be strongly advised to have more tests to make sure the baby’s healthy.

If there are any malformations, you’ll be told how to deal with that and what to do at the birth and after the birth.

Does epilepsy decrease your birth options?

Yes, it can do. Even if you’ve got good seizure control, other things like ongoing pain and stress can be seizure triggers for epilepsy, so all women who have epilepsy are advised to give birth in a hospital, with a consultant on call. This is just so if a seizure did happen, everything is in place to look after you and your baby.

Generally, women don’t have seizures in labour, but if they did they have care on hand. Research suggests vaginal birth and caesareans have the same rate for women with epilepsy as they do for women without epilepsy. 

“Some women worry that if they have a seizure, they have to have a caesarean, but the answer to that is it depends completely on what seizure you have and how well you are when you came round from the seizure,” explains Nicole.

Will you need to go into hospital earlier than usual?

Not necessarily, some mums might only need to go in when in labour.

“It’s only if you have other complications; that you might have to go into hospital earlier but the majority of women with epilepsy have straightforward pregnancies and straightforward labour,” says Nicole.

After birth

Is it possible to breastfeed your baby if you have epilepsy?

“The World Health Organisation (WHO) recommends breastfeeding, and that’s the same if you’re on anti-epilepsy medication,” explains Nicole.

Rather than being told not to breastfeed, you’re more likely to be told the sort of things to look out for – if mum’s well and baby’s well, you should be advised to breastfeed. But if the baby is having trouble with suckling, can’t suckle properly or baby’s not feeding well or if you’re worried baby is sleeping a lot it is worth telling your health visitor or GP immediately just to make sure the baby is okay.

Does epilepsy affect how you care for your newborn?

It can do. There is a slightly higher risk of having seizures after having a baby, because sleepless nights can be a trigger, which are common with a newborn baby!

“Think to yourself, ‘What kind of seizures do I have?’ and plan ahead about what might happen,” advises Nicole.

When breastfeeding, Nicole recommends that you sit on the floor with a cushion, so that if you did have a seizure and you drop the baby or the baby rolls, your baby won’t have far to drop.

If you’re worried about taking your baby to bed at night and having a seizure then, maybe carry the baby in a carrycot to give it some protection in case you dropped the baby.

If you’re going out and about with a toddler and are worried you’ll have a seizure when you’re in the park, put the child in child reins. Some women worry they’ll have seizure when pushing a pram and they might let go of the pram – there is a company called Remap who make automatic brakes for prams, so if you have a seizure and let go of the pram, it will stop.

The kind of things you can do, as a parent, to keep your baby safe depends on what kind of seizures you’re having and how frequent and whereabouts you are.

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For further information and support, visit Epilepsy Action at www.epilepsy.org.uk or call their helpline on 0808 800 5050.

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