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Page: << Prev | 1 | 2 Pre-pregnancy planning is key, according to the guidelines. The ideal is to be on one anti-seizure medication and to be on the lowest dose possible during pregnancy. And the time to experiment with different medications is before you get pregnant.
While it's best to avoid certain drugs, such as valproate and also phenytoin and phenobarbital, according to the guidelines, it's not always possible to do so. Some women must use these medications to control their seizures. And, having seizures during pregnancy is dangerous for both mother and baby.
"There are women who need to take valproate," said Harden, who added that these women should talk to their doctors to assess the risks before pregnancy. "The risk of malformations is higher, but 90 percent of babies born to women on valproate will not have major malformations," she said.
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A study in the April 16 issue of the New England Journal of Medicine found that valproate could cause lasting cognitive impairment in children exposed in-utero to the drug. And the study's lead author recommended that valproate shouldn't be a first-line medication for women of childbearing age, because so many pregnancies are unplanned.
Dr. Orrin Devinsky, director of the Epilepsy Center at New York University's Langone Medical Center, said he agreed with that recommendation. However, if a woman must be on valproate during pregnancy, she should try and get to the lowest levels possible and be aware of the risks. "Pregnancy is a risk/benefit decision for each woman," he noted.
As in women without epilepsy, smoking can increase the risk of premature labor and delivery in women with epilepsy, the experts added.
The guidelines also recommend that women with epilepsy follow the standard recommendation to take 400 international units of folic acid daily to help prevent birth defects.
"Before a woman with epilepsy gets pregnant, she should consult a doctor who's knowledgeable about epilepsy and pregnancy, reduce medications if possible, and start taking folic acid," said Devinsky, adding that "women who are well-controlled going into pregnancy tend to do well in pregnancy."
More information
To learn more about epilepsy and pregnancy, visit the Epilepsy Foundation.
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