Epilepsy During Pregnancy: Risks, Symptoms, Diagnosis & Management

Motherhood is undoubtedly a beautiful yet challenging experience. However, it can become relatively more difficult when you are facing the additional burden of a chronic condition such as epilepsy during pregnancy. In India, there are approximately 1.3 million women of childbearing age who live with epilepsy.¹     

In this blog, you will learn about the different causes and symptoms of epilepsy during pregnancy. You will also get to know how you can effectively manage this condition. But first, let’s start with the basics.     

What Is Epilepsy During Pregnancy?

Epilepsy is a neurological disorder characterised by abnormal electrical brain signals leading to seizures. Epileptic seizures are irregular, jerky, or trembling body movements caused by abnormal neuronal activity.² It's important to note that pregnancy itself does not cause epilepsy.³ However, when women with epilepsy become pregnant, their experiences with the condition during this time can vary significantly.

Did you know that around 20-30% of pregnant women may encounter an increase in seizure frequency? Intriguingly, a similar percentage, i.e. approximately 20-30%, may notice a decrease in their seizures! For the remaining 40-50% of women with epilepsy, it was found that their seizure patterns remain unchanged.¹

Having said that, let us find out more about the various causes of epilepsy during pregnancy.

Causes Of Epilepsy During Pregnancy

There are a couple of reasons why pregnant women with epilepsy tend to have increased seizure frequency:

• The medicines used to treat epilepsy work very differently during pregnancy. When a woman becomes pregnant, her body undergoes many changes which in turn may affect her ability to process these drugs.⁴
• Another reason for the increase in seizures is frequent nausea and a tendency to vomit. Pregnant women with epilepsy may vomit out the medication even before it is properly absorbed by the body.^{3, 4}

Having understood the cause of increased seizures during pregnancy, let’s move on to explore its signs and symptoms.

Symptoms Of Epilepsy During Pregnancy

While seizure is the most evident sign of epilepsy in pregnant (or non-pregnant) women, there are other tell-tale signs.

The most common symptoms include:⁵

• Confusion
• Headache
• Memory loss
• Dizziness
• Fainting
• Change in energy levels
• Mood changes

However, you must note that most of these symptoms also overlap with the symptoms of pregnancy itself. Hence it's important to check with your doctor for a confirmatory diagnosis.

So how is the diagnosis done? Read on to find out.

Does Epilepsy Make It More Difficult To Get Pregnant?

Usually, epilepsy doesn’t have any negative impact on your ability to get pregnant. Nevertheless, the medications which you might be taking to manage your seizures could have some role to play. Some anti-seizure meds can also increase your baby’s risk of being born with birth defects.

How Is Epilepsy During Pregnancy Diagnosed?

The majority of women with epilepsy receive their diagnosis before becoming pregnant. The diagnosis of epilepsy is typically confirmed through a detailed evaluation of your medical history and a physical checkup. 

Depending on the frequency of your seizures, your healthcare provider may decide to conduct various tests, which can include blood tests, electrocardiograms (ECG) for checking your heart, electroencephalograms (EEG) for monitoring your brain activity, and in some cases, CT scans or MRIs.³

How Does Epilepsy Affect Pregnancy? 

The risks associated with epilepsy during pregnancy are twofold. Complications may arise either due to the condition itself or result from the medications that are used to manage the seizures (the antiepileptic medications or AEDs).

• Hormonal fluctuations, stress, and a decline in the concentration of antiepileptic medications (medications used to manage seizures) in the body can all lead to increased seizure frequency during pregnancy. Additionally, the changes in water and salt concentration inside the body also contribute to the reduction in the efficiency of AEDs.
• A few types of seizures pose greater risks to both the mother and the baby. These risks include injuries resulting from falls or burns, elevated chances of preterm labour, miscarriages, and a reduction in the foetal heart rate.⁶
• Taking some anti-seizure medications during pregnancy can heighten the risk of birth defects, including issues like cleft palate (birth defects in baby’s lip and mouth⁷), neural tube defects (birth defects of the brain and spinal cord⁸), skeletal abnormalities, as well as heart and urinary tract problems. The likelihood of these side effects appears to rise with higher medication doses and when multiple anti-seizure medications are used. ^{4, 6, 9}
• Additionally, there is an increased chance of potential developmental problems in your baby, which might include delayed speech and language development, as well as issues with memory and attention. 

Does Epilepsy Change During Pregnancy

Did you know that around 20-30% of pregnant women may encounter an increase in seizure frequency? Intriguingly, a similar percentage, i.e. approximately 20-30%, may notice a decrease in their seizures! For the remaining 40-50% of women with epilepsy, it was found that their seizure patterns remained unchanged.

What About Medication?

The primary objective of treating epilepsy with medications is to manage seizures effectively. However, minimising the exposure of the unborn baby to anti-seizure medications is also paramount. This approach is crucial to reduce the potential risks to the baby's structural development and neurodevelopment.

Throughout pregnancy, the levels of anti-seizure medications or AEDs in the body can fluctuate due to various physical and physiological changes associated with pregnancy Therefore, it becomes necessary for the doctor to adjust the dosage of antiepileptic drugs (AEDs) to maintain levels similar to those before pregnancy.

AEDs which are known for having lower rates of serious birth defects in the unborn baby should be the preferred choices for women with epilepsy who are planning to become pregnant.

If you are pregnant with epilepsy, you must ensure that you are getting enough sleep and keeping stress at bay. You must also ensure to religiously take your prescribed medications on time. Additionally, consulting with your neurologist during this period is essential.

What If I Have A Seizure When I'm Pregnant?

Undoubtedly, seizures can be potentially dangerous while you’re expecting. But many women who do get seizures during pregnancy go on to have healthy babies. Just make sure to report any incidence of seizure right away to your doctor. They can make adjustments to your medications and even monitor the baby in the hospital if the need arises.

How Can I Make Sure My Baby Is Okay?

Your doctor will be regularly monitoring your baby’s health and well-being if you’re pregnant with epilepsy. They will also be conducting several ultrasounds and other prenatal exams to make sure that your baby is okay.

Will I Be Able To Breastfeed My Baby?

Yes. Women with epilepsy are actually encouraged to breastfeed their babies. That’s because breastmilk contains crucial nutrients for your baby. Moreover, your baby was anyway exposed to anti-seizure medications during the pregnancy. So breastfeeding might serve as a helpful way to wean them off those medicines. But if you’re still concerned about the medications, talk to your doctor about it. They might alter the medication or change the timings of your meds so that you feed your baby before taking them.

Can I Keep Taking My Epilepsy Medication During Pregnancy?

Anti-seizure medications might increase your baby’s risk of developing birth defects. So talk to your doctor so that they can prescribe you the safest medication during pregnancy or adjust the dosage as per your seizure frequency.⁶

Will My Baby Have Epilepsy?

In a few cases, epilepsy might be inherited or passed down from parents to their babies. So if you’re concerned about it, you can opt for genetic counselling to assess your risks and plan out your pregnancy better.¹¹

Managing Epilepsy During Pregnancy

The primary objective of treatment is to effectively manage seizures. Minimizing the exposure of the unborn baby to anti-seizure medications is also paramount. This approach is crucial to reduce the potential risks to the baby's structural development and neurodevelopment.

Throughout pregnancy, the levels of anti-seizure medications or AEDs in the body can fluctuate due to various physical and physiological changes associated with pregnancy Therefore, it becomes necessary for the doctor to adjust the dosage of antiepileptic drugs (AEDs) to maintain levels similar to those before pregnancy.

AEDs which are known for having lower rates of serious birth defects in the unborn baby should be the preferred choices for women with epilepsy who are planning to become pregnant.¹⁰

If you are pregnant with epilepsy, you must ensure that you are getting enough sleep and keeping stress at bay. You must also ensure to religiously take your prescribed medications on time.  Additionally, consulting with your neurologist during this period is essential.

Final Words

Women with epilepsy (WWE) face distinct challenges during pregnancy, including potential complications. To address this, education is paramount. Women with epilepsy should be informed about the possible complications that may arise during delivery, given the chances of increased risk. This awareness empowers them to make informed decisions about their care.

Moreover, a woman with epilepsy during pregnancy requires strict monitoring throughout the delivery process. While the journey from pregnancy to childbirth may hold concerns for them, timely intervention and specialised care significantly reduce associated risks. 

It is recommended to seek advice from a healthcare provider with expertise in obstetrics and gynaecology. These specialists possess the knowledge and skills to address such complications effectively, thus ensuring a happy mother and a healthy baby.

*Disclaimer: The information in this blog is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment.

FAQs

Q1. Do I Need To Take Any Extra Precautions If I’m Planning To Get Pregnant With Epilepsy?

It is important to have a plan before getting pregnant if you have epilepsy. You must talk to your doctor about the possible complications and how to avoid them.

Q2. Is It Hard To Get Pregnant With Epilepsy?

While previous studies have suggested that women with epilepsy may experience fertility issues, new research has shown that the likelihood of a woman with epilepsy getting pregnant is similar to that of a woman without the condition.¹¹

Q3. Can I Continue My AEDs During Pregnancy?

You might need to modify your dosage or transition to a different medication, but it's unlikely that you will have to discontinue medication entirely.¹¹

Q4. Will Getting Pregnant Cause More Seizures?

While there are risks, that is not always true. Approximately 20-30% of women with epilepsy might notice a decrease in the occurrence of seizures.¹

Q5. If I Have Epilepsy, Will My Baby Have It Too?

Epilepsy is sometimes genetic but mostly a child does not inherit it from their parents.¹¹

Q6. Can I Breastfeed With Epilepsy?

Breastfeeding is actively recommended by medical professionals and major health organisations, even when you are taking AEDs. Nonetheless, it is crucial to consult with your doctor to confirm the safety of the AED during breastfeeding.¹¹