Ideally, epileptic patients should receive counseling prior to becoming pregnant and begin taking folic acid to avoid the development of neural tube defects. The American Congress of Obstetrician-Gynecologists’ recommended dose of folic acid is 4.0 mg. If a woman has been seizure-free for two years prior to becoming pregnant, it is recommended that her medications be tapered for six months prior to becoming pregnant. If she is taking Valproate Acid, (also known as Depacon), then it should be replaced with a substitute because of its high incidence of birth defects.
Ideally, a pregnant woman with epilepsy should be on a simple routine of one or two medications only and at the lowest possible dose. Treatment with 4 or more medications increases the risk of the baby developing birth defects by 25 percent. Newer antiepileptic medications such as lamotrigine and oxcarbazepine are less likely to cause birth defects than older drugs however, more frequent blood levels need to be monitored closely to avoid the risk of increased seizures. Any decrease in the blood levels of these medications could have serious effects. The American Academy of Neurology and the American Epilepsy Society recommended that patients avoid receiving valproic acid, phenytoin, carbamazine and Phenobarbital during the first trimester to reduce risks of birth defects.
How often should an epileptic patient’s blood levels be checked? At minimum, the levels should be checked at the beginning of each trimester or monthly for lamotrigine or oxcarbazepine. Folic acid should also be continued. Screening tests such as alpha-fetoprotein should be done to rule out birth defects or fetal anomalies.
Seizures occur in 1 to 2 percent of patients during labor and in the post partum period, therefore all doses of medication should be continued while in labor and during the post partum period. According to medical studies, patients taking antiepileptic medications may breastfeed with the exceptions of those taking Phenobarbital, primidone or benzodiazepines because of increased irritability in the newborn.
If a patient’s medication dose has been changed during pregnancy, it should be changed back to the original dose during the first few weeks after delivery. Patients taking lamotrigine need to be monitored more frequently.
With proper management, 90 percent of epileptic patients can have a normal pregnancy and delivery. A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.