Epilepsy and Pregnancy: Navigating seizure risks and enhancing prenatal care

Epilepsy is a long-term neurological condition that causes brief episodes of involuntary movements due to irregular electrical activity in the brain. For women with epilepsy, pregnancy can present unique challenges.

According to vice chairman and HOD - neurology, BLK MAX Super Speciality Hospital Dr Atul Prasad, women can have healthy pregnancies despite epilepsy, but they tend to face increased complications. 

The risks may include, seizure exacerbation, medication teratogenicity, and complications such as preeclampsia or fetal growth restriction.

Dr Atul further shared what precautions shall be taken by  those females, who are to-be -mom or planning to  conceive. 

“Ideally, women with epilepsy should consult their healthcare team—neurologists and obstetricians—before conception."

This allows for a review of seizure control and antiseizure drugs. Consider switching to lower-risk anti-seizure medications (ASMs) and aim for monotherapy at the lowest effective dose,” added the neurologist.

Managing   seizure during pregnancy :

"Seizure frequency remains unchanged in approximately 50% of women but may worsen in 30%. Generalized tonic-clonic seizures (GTCS) are particularly dangerous."

The mentioned risk  can  contribute in  hypoxia, trauma, miscarriage, and sudden unexpected death in epilepsy.

Pregnancy risks:

Epilepsy can lead to higher risk of miscarriage, preterm birth, fetal growth restriction, preeclampsia. 

The doctor added that epilepsy does not increase the risk of C-section, but uncontrolled seizures may necessitate surgical delivery.

Prenatal monitoring:

Dr Atul shared: “Enhanced prenatal screenings, including detailed ultrasounds (18–22 weeks) and fetal echocardiography, help detect structural abnormalities."

He further revealed that, " Women on ASDs, particularly older agents like phenobarbital, may have higher risks of preterm birth or low birth weight. Monitoring for obstetric complications, such as preeclampsia, is also essential."

Labor, delivery, and postpartum:

The neurologist highlighted that, “Most women with epilepsy deliver vaginally, but stress and sleep deprivation during labour may trigger seizures. Postpartum, ASD doses may need readjustment as pregnancy-induced metabolic changes reverse. New mothers should prioritise sleep and seek help to mitigate seizure risks.”

Emotional and psychological support:

The epilepsy patients needs emotional supports to get them relief from anxiety.