Pregnancy is a transformative journey marked by numerous physiological changes, and for women with epilepsy, the experience may present additional considerations and challenges. Epilepsy, a neurological disorder characterized by recurrent seizures, can have implications for both the mother and the developing fetus. In this article, we explore the impact of epilepsy on pregnant women, highlighting key considerations for managing maternal health during this critical period.

1. Seizure Control and Medication Management

Maintaining optimal seizure control is of paramount importance during pregnancy. Uncontrolled seizures can pose risks to both the mother and the unborn child. However, the challenge lies in balancing the need for seizure control with the potential deleterious effects of antiepileptic medications on the developing fetus.

Women with epilepsy must work closely with their epileptologists or neurologists to find a medication regimen that effectively manages seizures while minimizing potential risks to the baby. Some anti-epileptic medication dosages may need to be increased due to metabolic changes during pregnancy.

2. Increased Risk of Complications

Pregnant women with epilepsy may face an increased risk of certain complications. Studies suggest a higher likelihood of preterm birth, low birth weight, and an elevated risk of congenital malformations, particularly when antiepileptic medications are used. Women with epilepsy are also at a higher risk of pre-eclampsia, pregnancy-induced hypertension, increased risk for post-partum delivery, and a higher likelihood of cesarean delivery.

Regular prenatal care and close monitoring can help mitigate these risks, allowing healthcare professionals to address any emerging issues promptly. Also, regular antenatal checkups with the obstetrician, along with anomaly scans to detect congenital malformations, are recommended.

3. Folic Acid Supplementation

Folic acid is essential for fetal development, and its supplementation is particularly important for women with epilepsy who may be taking antiepileptic medications. Some of these medications can interfere with the body’s ability to absorb folic acid. Therefore, healthcare providers often recommend higher doses of folic acid to ensure the developing fetus receives an adequate supply, reducing the risk of neural tube defects.

4. Hormonal Changes and Seizure Frequency

Pregnancy itself induces hormonal changes that can influence seizure frequency in women with epilepsy. While some experience a decrease in seizures during pregnancy, others may see an increase. Hormonal fluctuations, particularly in the first and third trimesters, can contribute to these variations. Careful monitoring and adjustments to medication may be necessary to manage seizure activity effectively.

5. Postpartum Considerations

The postpartum period is another critical phase for women with epilepsy. Changes in sleep patterns, increased stress, and potential alterations in medication can contribute to an increased risk of seizures. It is essential for healthcare providers to continue close monitoring during this period, supporting the new mother in managing her epilepsy while caring for her newborn.

Pregnancy for women with epilepsy requires a multidisciplinary approach, involving collaboration between neurologists, obstetricians, and other healthcare professionals. While challenges exist, with careful planning, monitoring, and communication, many women with epilepsy can have successful pregnancies and healthy babies.

Women with epilepsy planning to become pregnant or those who are already pregnant should seek guidance from their neurologists to develop a personalized care plan. Through proactive management and support, women with epilepsy can navigate pregnancy safely and experience the joys of motherhood while prioritizing their own health and the well-being of their children.

About the author- Dr Aparajita Chatterjee, Consultant Neurology, Fortis Anandapur, Kolkata