Kim Morley, Epilepsy Specialist Midwife Practitioner and winner of the 2016 Emma’s Diary’s UK Mums’ Midwife of the Year Award, answers your frequently asked questions about epilepsy and pregnancy.
For most women, their epilepsy remains unchanged during pregnancy. However, some women experience more frequent seizures, a change in seizure severity or pattern or an improvement in their seizure control. This is why your doctors will want to closely monitor your condition. The majority of women who currently have epilepsy will be advised to give birth in a hospital maternity unit with consultant obstetric cover.
If your epilepsy has been well controlled for at least nine months before pregnancy, it is more likely to stay controlled during pregnancy*. Research suggests that pregnant women with focal epilepsy are more likely to have a recurrence of seizures than women with generalised epilepsy**. Blood levels of some antiepileptic drugs (AEDs) reduce during pregnancy causing an increased risk of seizures. Therefore, your specialist may recommend drug monitoring and extra medical supervision, especially if you are taking lamotrigine2.
Suddenly stopping or reducing AED dosage may cause an increase in seizures and a risk to life. If you are concerned about the effect of AEDs on your unborn baby, discuss this urgently with your doctor. It’s really important not to stop your AEDs without consulting your health professionals.
You should see your doctor as soon as possible so your epilepsy and treatment can be reviewed. If you are having on-going seizures despite AEDs, your doctor will provide advice and arrange for you to be referred to an epilepsy specialist and obstetrician. If you take AEDs and have not started taking a daily dose of 5mgs folic acid, your doctor will prescribe this for up to and including the 12th week of pregnancy.
To assist your maternity care, a multi-professional shared care plan will provide a summary of your epilepsy and can be downloaded from: https://www.epilepsy.org.uk
If you experience morning sickness or any other vomiting in pregnancy you may need to alter the times you take your AEDs. If you need advice about this or the vomiting continues, contact your doctor urgently as vomiting can affect the absorption of your AEDs, which can cause a recurrence of seizures.
There is a small increased risk of harm to a woman and her unborn during a tonic clonic seizure, especially if the seizure is prolonged. To protect yourself, ensure family/friends are aware of appropriate first aid. Seek urgent help from your healthcare team if you have recurrence of seizures in pregnancy. Visit Epilepsy Society for advice on first aid for convulsive seizures.
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
*Harden C, Hopp J, Ting T, Pennell P, French J, Le Guen C, et al. Practice Parameter update: Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): Obstetrical complications and change in seizure frequency Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 2009; 73(2): 126-132.
**Battino D, Tomson T, Bonizzoni E, Craig J, Lindhout D, Sabers A, et al. Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry. Epilepsia 2013; 54(9):1621-7.