Dr. Marjorie Greenfield
Specializing in pregnancy and birth.
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 Ask Dr. Greenfield
Seizure Disorder and Pregnancy | | | QUESTION | | | Dear Dr. Greenfield,
I have a seizure disorder and am afraid I might have one during the pregnancy. Could this hurt the baby?— Scaredmom in Tampa, Fl | | | ANSWER |
February 25, 2002 | | | Dear Scaredmom,
First the good news--more than 90 percent of women with a seizure disorder have healthy babies. Keep this in mind as you learn about some of the not as good news.
Seizure disorders (epilepsy) increase the chances of birth defects for two reasons. First, most of the medications that people take for seizures have the potential to cause birth defects. Second, there is something about having epilepsy itself that may increase this risk. Mothers-to-be who take more than one medication have a greater chance of problems. I don't know what kind of seizures you have, but prolonged grand mal seizures are bad for both mother and baby and should be avoided. Most mothers-to-be don't have an increase in their seizure frequency during pregnancy.
I can't tell from your email if you are already pregnant. In general, all women with epilepsy should see their doctors when planning a pregnancy. Pre-pregnancy appointments with your neurologist and obstetrician can help make sure you are in the best possible condition before pregnancy, and help you understand what you can do, even before you are pregnant, to help protect the baby.
What should a woman with a seizure disorder do once she is pregnant? Work with your neurologist to achieve the best possible seizure control. Even though the medications occasionally cause problems for the baby, most babies come out fine. Pregnancy can affect your blood level of antiseizure medications. Your obstetrician or your neurologist will check these levels during the pregnancy. Your medication dose will probably need to be adjusted a few times.
There are some medications that may be safer than others, but most women stay on their usual meds to avoid having to worry about seizures. Also, taking 1 mg (1000 mcg) a day of folic acid in the early first trimester can help prevent the increased risk of spina bifida associated with some of the seizure drugs, including valproate.
Most women with seizure disorders will have a triple check test when they are around 16 weeks along and a detailed ultrasound at about 18 weeks to check for major birth defects in the developing fetus. The most common problems are spina bifida, cleft lip, and heart defects. Please remember that more than 90 percent of these babies have totally normal anatomy.
— by Marjorie Greenfield, M.D. |
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