Anti-Seizure Medications During Pregnancy: Are They Safe?
If you have epilepsy, becoming pregnant might seem daunting, but the odds are in your favour with proper care and planning.For many patients, epilepsy should not be a barrier to having children, but it comes with its own set of challenges that require careful planning. The impact of seizures and the medications used to manage them raise specific concerns during pregnancy.Is it safe to continue these medications while pregnant, and could they pose risks to the baby? We spoke with Dr N Sapna Lulla, Lead Consultant - Obstetrics & Genecology, Aster CMI Hospital, Bangalore to gain her expert insights on the matter.
Is It Safe For Pregnant Women To Take Anti-Seizure Medications?
Most women with epilepsy can expect to have a healthy baby, with the risk of congenital malformations being low, especially if certain medications are avoided during the peri-conception period. Dr. Lulla told us, ”It’s important to understand that the risk of birth defects can be influenced by the type, number, and dosage of medications used. For instance, taking multiple medications or high doses may increase the risk of anomalies.”
Medications like Carbamazepine and Lamotrigine have limited evidence to suggest they don't impact the neurodevelopment of the baby. Similarly, there is little evidence linking Levetiracetam and Phenytoin to developmental issues in children.
However, according to a research study by the National Center for Biotechnology Information, pregnancy can lead to an increased clearance of certain antiseizure medications, such as Levetiracetam, Lamotrigine, and Oxcarbazepine. This can cause a drop in serum levels by 35% or more, which may increase the risk of seizures during pregnancy. Therefore, it is recommended to monitor serum levels of these medications at least once per trimester.
More frequent monitoring may be necessary if there are clinical changes, such as an increase in seizure frequency or the appearance of adverse effects.
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Specific Risks Associated With Taking Anti-seizure Medications During Pregnancy
Dr. Lulla advises that certain medications used to treat epilepsy, such as Sodium Valproate, can lead to common congenital malformations in the fetus. These include neural tube defects (NTDs), facial clefts, and hypospadias. Medications like Phenobarbitone and Phenytoin are associated with cardiac malformations, while Phenytoin and Carbamazepine may increase the risk of cleft lip. To reduce the risk of major congenital malformations, women with epilepsy are strongly recommended to take 5 milligrams of folic acid before conception and continue through the first trimester of pregnancy.
Precautions For Pregnant Women On Anti-seizure Medications
Dr. Lulla recommends several precautionary tips for women on anti-seizure medications during pregnancy:
- Monitoring and Consultation: Two-thirds of women with epilepsy will not experience worsening seizures during pregnancy. However, those who have been seizure-free for a year before conception should be closely monitored throughout pregnancy. Dr. Lulla said, “It's essential for healthcare providers to inform them about prenatal screenings, potential risks to the fetus, the impact of seizures, and the effects of medications on pregnancy, breastfeeding, and contraception. Abruptly stopping or changing medications is not advisable without a thorough, informed discussion.”
- Fetal Anomaly Scan: A fetal anomaly scan between 18 to 20 weeks can help identify major issues such as cardiac defects and neural tube defects. Additionally, all newborns should receive a vitamin K injection to prevent hemorrhagic disease that could result from medications taken during pregnancy.
- Seizure Management During Labor: The risk of seizures during labor is very low, but it’s important to address potential triggers like pain, sleep deprivation, stress, and dehydration, which can lead to seizures.
- Post-Delivery Care and Breastfeeding: After delivery, women should continue their anti-seizure medications to ensure the safety of both the mother and baby. Current research shows that there are no significant adverse effects on cognitive development in children exposed to anti-epileptic drugs during pregnancy or breastfeeding. Therefore, women are encouraged to breastfeed rather than use formula milk.
- Postpartum Medication Review: If a woman’s dosage or number of medications was increased during pregnancy due to seizure deterioration, she should be reviewed about 10 to 14 days after delivery. This helps reduce the dosage if necessary, preventing potential medication toxicity for the mother.
With the right preparation and medical care, many women with epilepsy have healthy pregnancies and deliver healthy babies. Always consult with your healthcare provider to make informed decisions and reduce risks to you and your baby.
Source: herzindagi.com, Itisha Arya