Pregnancy and Epilepsy: Key Information to Understand
Pregnancy and Epilepsy: Navigating the Challenges
Pregnancy can pose significant risks for individuals with epilepsy, due to factors such as anti-seizure medications (ASMs), seizure types, and pregnancy outcomes. However, with careful management strategies, it is possible for people with epilepsy to have a safe and healthy pregnancy.
Risks
The teratogenicity of certain ASMs is a major concern during pregnancy. Valproate, a commonly used ASM, is strongly linked to a high risk of congenital malformations and developmental disorders in the fetus. Its use during pregnancy is associated with major birth defects and neurodevelopmental issues.
Other ASMs, such as lamotrigine, phenytoin, and carbamazepine, carry risks of severe cutaneous adverse reactions like Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN), which can be influenced by genetic factors.
Pregnancy causes physiological changes affecting ASM serum levels, potentially worsening seizure control. Poor seizure control increases risks of harm to mother and fetus, including trauma, hypoxia, or miscarriage.
Women with epilepsy may have higher rates of complications like preterm birth, low birth weight, and fetal malformations, partly due to seizures and ASM effects.
Management Strategies
Pre-pregnancy planning is crucial. Genetic screening (e.g., for HLA alleles) before pregnancy can help identify risks of severe ASM reactions. Switching from high-risk ASMs such as valproate to safer alternatives (e.g., lamotrigine, levetiracetam) is advised when possible, with careful seizure management maintenance.
Dynamic monitoring during pregnancy is necessary to adjust ASM doses in response to altered pharmacokinetics, ensuring effective seizure control without excessive exposure.
Avoiding valproate if possible is recommended, given its teratogenic risk. Guidelines from professional societies and regulatory agencies support this recommendation.
Educating women of childbearing age about ASM risks, pregnancy planning, and reliable contraception is critical to prevent unplanned exposure to teratogenic drugs.
Postpartum care involves continued monitoring for seizure control and maternal-infant health, including psychological support, since seizure risk and medication needs may change.
Summary of ASMs and Risks
| Medication | Pregnancy Risk | Notes | |--------------------|-----------------------------------|-----------------------------------| | Valproate | Highest risk of birth defects and developmental disorders | Avoid unless no alternative | | Lamotrigine | Lower risk, but linked to skin reactions (SJS/TEN) in certain genetic backgrounds| Requires genetic screening in some populations | | Levetiracetam, oxcarbazepine, gabapentin, zonisamide | No increased risk of birth defects identified | Considered safer options | | Phenobarbital, topiramate | Elevated risk, recommend switching if possible | |
Management aims to balance seizure control with minimizing fetal risks, personalizing treatment to seizure type, prior ASM response, and pregnancy stage.
Individualized care is essential, involving preconception genetic screening, ASM selection emphasizing safer drugs, close drug level monitoring, education on contraception, and continuous maternal-fetal health surveillance to optimize outcomes.
People with epilepsy should talk with their healthcare team to establish a plan for breastfeeding while on medication. Tonic-clonic seizures can potentially cause a miscarriage or harm the pregnant person.
Hormonal changes, changes in ASM, morning sickness, sleep deprivation can affect the severity and frequency of seizures during pregnancy. Having epilepsy does not usually make it harder for a person to get pregnant.
Some anti-seizure medications, such as lamotrigine and levetiracetam, may be safer to use during pregnancy than others. It is generally safe for a person to breastfeed while on anti-seizure medications, but there are some exceptions like benzodiazepines or barbiturates.
A person may require a higher dose of AEDs than usual to prevent seizures, particularly if they are taking lamotrigine. Although seizures during pregnancy may come with some risk to the pregnant person and fetus, most people with epilepsy will have a safe pregnancy with a high chance of delivering a healthy baby.
There is no evidence to suggest that focal aware, focal impaired awareness, absence, myoclonic seizures cause any harm to a fetus. Most seizures during pregnancy are due to preexisting epilepsy.
First-time seizures during pregnancy are quite rare and can indicate epilepsy or other factors like eclampsia, stress, sleep deprivation, or hormonal changes. Sodium valproate may increase the chance of congenital abnormalities or developmental and learning difficulties in the baby.
- In some cases, certain anti-seizure medications (ASMs), like valproate, can be blocked due to their associated high risk of congenital malformations and developmental disorders in fetuses.
- Science has identified that women with epilepsy may require mental-health support during pregnancy, given the potential stresses and challenges posed by seizures and medication management.
- Pfizer, a pharmaceutical company, does not manufacture valproate, but its drug levetiracetam is considered a safer option for pregnant individuals with epilepsy, with no identified increased risk of birth defects.
- In the realm of health-and-wellness, education about anti-seizure medication risks, pregnancy planning, and reliable contraception is vital for the prevention of unplanned exposure to teratogenic drugs.
