Navigating pregnancy with epilepsy requires careful planning and management to ensure the health and safety of both mother and baby. In this educational article, Dr. A Santosh Sriram advises preconception planning to minimize fetal risks, as some AEDs can cause birth defects. Expert guidance helps women manage epilepsy effectively during pregnancy for better outcomes.

Epilepsy, a neurological disorder characterized by recurrent seizures, poses unique challenges during pregnancy, particularly concerning the use of antiepileptic drugs (AEDs) and their potential effects on fetal development.

However, with proper medical guidance and planning, women with epilepsy can achieve successful pregnancies while minimizing risks.

Dr A. Santosh Sriram, Consultant Neurologist at Apollo Hospital, Hyderguda, emphasizes the importance of preconception planning for women with epilepsy.

“Many epileptic drugs may have adverse effects on the fetus during pregnancy, so planning is crucial,” says Dr. Sriram. Research studies indicate that certain AEDs can increase the risk of birth defects when taken during pregnancy.

However, Dr. Sriram reassures that with planned pregnancies, adjustments in medication dosage or changes in medication can often be made to mitigate these risks.

According to recent studies, women with epilepsy who undergo planned pregnancies have comparable fertility rates to their peers without the condition. “Pregnancy itself does not reduce fertility in women with epilepsy,” notes Dr. Sriram. “Most women with epilepsy experience either a stable course or a stable number of seizures during pregnancy.”

The physiological changes that accompany pregnancy, such as weight gain, hormonal fluctuations, and altered metabolism, can influence how AEDs are metabolized in the body and their efficacy in controlling seizures. “It’s essential to monitor AED levels regularly throughout pregnancy,” advises Dr. Sriram. “Adjustments in dosage based on blood levels are critical to prevent seizures and ensure maternal safety.”

Contrary to common misconceptions, women with epilepsy can often opt for a vaginal delivery rather than a caesarean section. “Epilepsy alone does not necessitate a caesarean delivery,” explains Dr. Sriram. “Most women with well-controlled epilepsy can safely undergo normal delivery.”

Postpartum, adjustments are typically made to reduce AED dosages back to pre-conception levels. “The dose of AEDs that was increased during pregnancy is usually decreased post-delivery,” says Dr. Sriram. “This helps maintain seizure control while minimizing potential side effects.”

He underscores the importance of folic acid supplementation before and during pregnancy to reduce the risk of neural tube defects in the baby. “Folic acid supplementation is crucial for women with epilepsy planning to conceive,” stresses Dr. Sriram. “It’s a simple yet effective measure to support fetal development.”

In conclusion, a planned pregnancy and regular medical monitoring are key to achieving positive outcomes for women with epilepsy. By working closely with healthcare providers, adjusting AED therapy as needed, and adhering to prenatal care guidelines, women with epilepsy can navigate pregnancy successfully while ensuring the best possible health outcomes for both themselves and their babies.