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Pregnancy Bliss | Reproductive Health Hub

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What are the chances of the baby developing epilepsy himself or herself, later on in life?
Approximately 10 per cent. Again, this is regardless of which parent is affected. Conversely, it is important to remember that 90 per cent of all children born to an epileptic parent will not be affected by this condition.

Anticonvulsant medication changes in Pregnancy
Are any changes required in the dosage of the anticonvulsant medication during pregnancy?
In theory, you may require an increase in the dose of your medication. In practice, most physicians have found this to be unnecessary and therefore tend to stick to the same pre-­pregnancy regime.
Your doctor may, however, want to check the drug levels in your blood from time to time. If this is found to be well below the acceptable therapeutic range, the case for increasing the dose may be compelling, even in the absence of seizures. After all, the aim is to prevent these from occurring.

Are any special measures required in labour for a woman with epilepsy?
No. Labour does not increase the risk of seizures and no special measures are called for.

Are any special measures required after delivery?
For the mother, no, but you will be strongly advised to have vitamin K given to the baby, which counters the increased bleeding tendency that these babies are especially prone to. The case for vitamin K is certainly stronger for these babies, even though vitamin K is recommended for and administered to practically all newborns.
In many cases, the mother will have taken Vitamin K1 supplements in the tail-end of their pregnancies to minimize the risk to the baby even further.

What place does pre-conception counselling have in epilepsy?
The various issues touched upon here make it clear that pre-­conception counselling is ideal. It is essential that the issue of fetal anomalies associated with this condition and its treatment is fully discussed and understood.                                                                   It is also important to explore possibilities of either stopping or changing medication in the period leading to pregnancy, i.e. before starting to try for a baby. For those on Sodium valproate (valproic acid), if it is not possible to change, pre­conception use of folic acid will be strongly advised, as it will minimise the risk of spina bifida (associated with this type of medication).

What are the specific anomalies of the various anticonvulsants?

Valproic acid: This is associated with a 1-2% increased risk of neural tubal defects, particularly at doses above 1000 mg/day.

Phenytoin is known to decrease the absorption of folate and is associated with characteristic fetal hydantoin syndrome, with effects including growth restriction, microcephaly, dysmorphic facies, and mental deficiency; noted in 11% of fetuses exposed to phenytoin in utero.

Trimethadione: Fetal trimethadione syndrome is associated with simian creases in the hands, cardiac anomalies, irregular teeth, and mental retardation with 50% incidence.

Phenobarbital: This is not associated with an increase in any anomaly, but it was associated with decreased intellectual performance at age 22 years in a Danish registry.

Carbamazepine: This is associated with craniofacial defects, hypoplasia (poor development) of fingernails, developmental delay, and spina bifida.

Lamotrigine: Children of patients on Lamotrigine as the only anticonvulsant in pregnancy appear to have no increased risk of congenital anomalies. However, when Lamotrigine is combined with another anticonvulsant, rates of congenital anomalies go up roughly two-fold.