Managing Epilepsy And Pregnancy – Part II

The apparent alterations in seizure frequency during pregnancy are possibly caused to various factors like:

• Hormonal fluctuations in the levels of estrogen and progesterone.
• Metabolic causes due to increased water and sodium retention.
• Psychological reasons like stress, anxiety that is associated with pregnancy or other factors.
• Lowered serum levels of Anti-epileptic drugs either due to nonconformity, delusional effect or varying drug approval.
• Physiological causes due to sleep deficit and Physical tension.

It is normally considered that WWE have decreased fertility rate. It is also noticed that women with epilepsy are more prone to polycystic ovarian disease or PCOD. The use of the anti-epileptic drug sodium valproate or VPA has been shown to be linked with the presence of PCOD that reverses when sodium valproate is substituted with another AED medicine.

The frequency of caesarean section in WWE may be increased though a majority of them do have normal vaginal delivery. Caesarean operation is indicated in WWE when:

• There is decreased co-operation by the patient for labor.
• The patient has negligible control over seizures when there are daily episodes of complex partial seizures.
• There is failure of induction of labor or the patient is heavily sedated.
• Widespread seizures occurring during labor or close to due date, foetal distress or due to other obstetric indications.

The risk of major abnormalities in babies born to WWE who take Anti-epileptic drugs is a huge concern. Such malformations necessitate surgical intervention like neural tube defects, cleft lip, cleft palate, hip dislocation, club foot, heart, gastro-intestinal, connective tissue, central nervous system, skeletal and renal abnormalities, undescended testes. Such children born to epileptic mothers taking anti-epileptic drugs have low birth weight, decreased length and head circumference.

Most studies have shown that the risk of foetal malformations is likely to be low with monotherapy – the use of relatively low dosage of AEDs, spacing out the daily dose into multiple doses and pre-conception intake of folic acid. It might be possible to halt AED intake if the patient has been seizure-free for greater than a year or two. The check up for foetal deformities must be undertaken during the conclusion of the first trimester.

Majority of the AEDs tend to pass on to breast milk in inverse proportion to their protein binding. The benefits of breastfeeding are seen to be possibly far greater than the potential risk to the child. Nonetheless, children need to be cautiously observed for any undesirable effects relating to AED exposure via breast milk.

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