Managing seizures during pregnancy
Management of epilepsy during pregnancy is key to having a healthy baby. Pregnant women with seizure conditions rely on Los Angeles’s best high-risk pregnancy specialist, Dr. Steve Rad. The doctor can help you during the delicate balancing act of pregnancy and seizures. We assist in overseeing your seizure medication, quality of life, and prenatal screening for expectant mothers who worry about epilepsy during their pregnancy.
Dr. Rad also offers preconception counseling to address labor and delivery issues, minimizing fetal risk, postpartum care for mother and baby, and contraception to avoid unplanned pregnancy.
What is epilepsy’s definition?
Epilepsy is a chronic disorder, the hallmark of which is recurrent, unprovoked seizures. According to the Epilepsy Foundation, a person is diagnosed with epilepsy if they have two unprovoked seizures (or one unprovoked seizure with the likelihood of more) that were not caused by some known and reversible medical condition like alcohol withdrawal or extremely low blood sugar.
Epileptic seizures, which affect 3.4 million Americans, may be related to a brain injury or a family history. But often the cause is completely unknown. The word “epilepsy” does not indicate anything about the cause of seizures or their severity.
Epilepsy is the fourth most common neurological disorder after Alzheimer’s disease, migraine, and stroke. The majority of seizures (about 57%) originate in one particular side of the brain and are known as focal seizures.
Other seizure types and epilepsy syndromes are generalized tonic-clonic seizures, clonic seizures, tonic seizures, and atonic seizures.
According to the National Institute for Health and Care Excellence, about 24% of people with epilepsy have been diagnosed with a mental health disorder compared with 11% of those without epilepsy.
Can epilepsy affect pregnancy?
Absolutely, yes. Having epilepsy makes your pregnancy high risk. Epilepsy is one of the most common disorders in women of reproductive age; about 24,000 babies are born to epileptic women in the United States annually.
Women suffering from a seizure disorder have unique concerns when pregnant. Women with epilepsy are at increased risk for a wide range of perinatal complications such as:
- premature delivery
- fetal growth restriction
- cesarean delivery
- increased risk of maternal mortality
With close monitoring, treatment, careful management of your anti-epileptic medications, and fetal monitoring with an expert Maternal-Fetal Medicine physician, the pregnancy-associated risks may be reduced to help you have a healthy pregnancy and baby.
Can pregnancy cause seizures?
Some women, approximately 15-30%, will experience enhanced seizure frequency during pregnancy.
While medical experts do not know exactly why some patients have pregnancy seizures, several theories suggest what may trigger convulsions. These include:
- Hormone changes
- Water and sodium retention
- Stress levels
- Decreasing antiepileptic drugs (AEDs)
- Lack of sleep
- Not taking AEDs as prescribed
- Poor seizure control before pregnancy
One of the strategies is for patients to pay close attention to seizures during the nine months before trying to conceive. Mothers who have been seizure-free for those nine months have a good chance of being convulsion-free during pregnancy.
Therefore, we recommend that you meet with your Neurologist and Maternal-Fetal Medicine specialist for pre-pregnancy or pre-conception counseling to optimize your seizure control and management before getting pregnant. This increases your odds of a healthier and safer pregnancy.
Does seizure medication affect pregnancy?
Though certain AEDs can carry adverse effects during pregnancy, it is critical to work with your doctor to maintain good seizure control. Epilepsy specialists agree that the risk of seizures is more severe than the risk of most AEDs.
At the onset of pregnancy, patients are encouraged to register with the North American Anti-Epileptic Drug Pregnancy Registry. This all-volunteer organization of 13,500 women continually adds to its knowledge base to inform patients and doctors about AEDs. The organization recommends the most effective anti-convulsive drugs and those that may generate side effects.
Major congenital malformations are more common in fetuses exposed to AEDs. AEDs may also be associated with cognitive and neurologic development problems.
Doctors agree that AEDs are okay while breastfeeding.
- Valproate or valproic acid (VPA), when used during the early days of pregnancy, has a 1-2% risk of neural tube defects (lack of spinal closure) and a 10% risk of major congenital malformation in newborns. According to the Centers for Disease Control (CDC), mothers taking Valproate generally have children with a below-normal IQ.
- Topamax taken during pregnancy increases the risk of cleft lip and/or cleft palate, a birth defect that can develop before you even know you are pregnant.
- Carbamazepine should be avoided during pregnancy because of its potential to cause birth defects.
- Phenobarbital has been shown to cause fetal abnormalities. Use during the first and third trimesters may be associated with an increased risk of teratogenicity (capable of causing malformations) and withdrawal symptoms in the newborn.
- Phenytoin has an increased risk of congenital abnormalities.
Dr. Rad is well-versed in the newer epileptic drugs that have a lower risk of birth defects. A partial list includes lamotrigine, oxcarbazepine, topiramate, gabapentin, and levetiracetam. During your consultation, the doctor will discuss the best, safest medication for managing your epilepsy. Follow-up visits will be required to monitor their effectiveness.
Treatment of epilepsy in pregnancy
Working with Dr. Rad, you can develop behaviors that greatly reduce your chance of seizures during pregnancy. These include:
- Taking folate (folic acid) before and during pregnancy. It is especially important during the first trimester before the neural tube closes (24-28 days after conception). A daily multivitamin containing 0.4 mg of folate and an extra 1-4 mg folate supplement is recommended.
- Selenium and zinc are also contained in many multivitamins and may prove beneficial.
- During the last month of pregnancy, experts suggest taking vitamin K to prevent rare bleeding complications with the newborn.
- Try to take the lowest dose of AED that will still be effective. Being on a single AED may decrease the chance of birth defects and autism. Dr. Rad will work with a neurologist to monitor your AED levels during pregnancy.
- Monitor the baby with maternal serum-alpha-fetoprotein testing and high-resolution ultrasound.
Why choose Dr. Steve Rad for seizure disorders in pregnancy?
Did you know that all pregnancies in the United States are at risk of becoming high-risk? Even a pregnancy that begins “low-risk” can become high-risk. That is no secret to double-board certified Dr. Steve Rad, an Obstetrician-Gynecologist with sub-specialty training in Maternal-Fetal Medicine / Perinatology.
Dr. Rad has been named a top Maternal-Fetal Medicine specialist in Los Angeles by Los Angeles Magazine for six years in a row.
Call us at (844) 473-6100 or schedule your consultation online. We are currently accepting new patients.
We are conveniently located for patients throughout Southern California and the Los Angeles area at locations in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, Newport Beach, Irvine, and Downtown Los Angeles. We also offer in-home prenatal care and a fly-in program for out-of-town and international patients. Dr. Rad even travels to patients who need him throughout the U.S. and around the world.
If you can’t make it to Dr. Rad, he also offers virtual consultations worldwide.