Q&A extract from emmasdiary.co.uk
Kim Morley, Epilepsy Specialist Midwife Practitioner and winner of the 2016 Emma’s Diary Mums’ Midwife of the Year Award, provides advice on planning your pregnancy if you have epilepsy and answers your FAQs.
Epilepsy is a serious neurological disorder in which unpredictable seizures occur as a result of sudden bursts of excessive electrical activity in the brain. It is usually diagnosed before the age of 20 and over the age of 65, but it can occur at any time. The symptoms are individual to the person they are affecting and dependent on where in the brain they start. If a seizure starts on one side of the brain, it is called focal and if it starts on both sides of the brain, it is called generalised.
About 2,500* births occur annually to women with epilepsy in the UK.
The majority of women with epilepsy have a healthy baby following a normal pregnancy and labour, but it is important to reduce the risk of harm through careful pregnancy planning.
Anti-epileptic Drugs (AEDs can be associated with an increased risk of birth defects. The risk is often low but will depend on the type and number of AEDs prescribed, the dosage, and whether there is a family history of congenital malformations. The risk of malformations and developmental problems in childhood is particularly increased in women prescribed sodium valproate in pregnancy.
All women with epilepsy should have pre-conceptual counselling to discuss their medication and seizure control. If this isn’t possible, because the pregnancy was unplanned, they should be seen as soon as possible by their doctor so that appropriate care during pregnancy and follow up of their epileptic condition can be organised. Hospital based maternity care will be planned alongside the care of the Neurologist/Epilepsy service as needed. Sometimes a referral will be made to the epilepsy team at the hospital where the baby is to be born.
Do not suddenly stop AEDs without seeking urgent medical advice from your doctor/epilepsy specialist. Your medication may be changed to one more suitable for pregnancy in discussion with your healthcare professionals. Suddenly stopping AEDs can be associated with uncontrolled seizures resulting in serious harm and in rare cases, sudden unexpected death.
Women with epilepsy are advised to take a daily dose of 5 mgs folic acid for at least three months before stopping contraception or if there is risk of unplanned pregnancy. This should be continued until the 12th week of pregnancy as it is thought to reduce the risk of neural tube defects, including spinal bifida.
Some AEDs induce enzymes in the liver, which reduce the effectiveness or oral contraceptives, the implant, hormonal patches and the reliability of natural methods of contraception. In addition, the combined oral contraceptive can reduce the effectiveness of lamotrigine. Therefore, it is advisable to seek advice from your GP or contraception/sexual health clinic to reduce the risk of unplanned pregnancy.
Kim Morley is an Epilepsy Specialist Midwife Practitioner with the Hampshire Hospitals Foundation Trust and is the winner of the 2016 Emma’s Diary Mums’ Midwife of the Year Award
*Source: UK epilepsy and pregnancy register