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There are no doubts. For women with epilepsy, having a baby can be more complex. But thanks to advances in science today in the vast majority of cases there are no problems and well over 90 percent of women with epilepsy have a successful pregnancy.
As if that were not enough, pregnancy only rarely negatively affects the frequency of seizures, indeed 20-30 percent of women with epilepsy will have an improvement in frequency during gestation. Furthermore, the probability that children of parents with epilepsy inherit the disease is very low, just above the average, about 4-6 percent more than the general population.
“If epilepsy – explains Barbara Mostacci, head of the Epilepsy and Gender Commission of the Italian League Against Epilepsy – LICE – is a condition that still presents many problems from a diagnostic and social point of view, when it comes to women who want to become mothers , the difficulties increase. A slightly increased risk of complications and malformations, coupled with social stigma and psychological factors have long prevented women with epilepsy from becoming a mother. But epilepsy is not a reason to renounce pregnancy, which can indeed be brought to a happy fulfillment by taking care to take some precautions “.
Planning the sweet expectation
It is important that, together with the specialists who follow her, the woman plan your pregnancy. In fact, a slight increase in the risk of congenital defects has been observed in babies exposed during the first trimester of pregnancy to some antiepileptic drugs, especially if taken at high doses. However, it must be said that by planning the gestation it is possible to reduce the malformative risk.
In fact, if it is almost never possible to stop the use of antiepileptic drugs in view of pregnancy, given that the risk of seizures is greater than that related to drugs, some therapeutic strategies can minimize the risk of malformations while ensuring good seizure control in the mother.
What to do? Having said that it is always necessary to define the situation case by case, it is useful, when possible, to resort to a single antiepileptic drug, chosen from among those at lower risk, at the minimum effective dose. It is also very important, as for other women, to supplement with folic acid at least 2-3 months before conception and during the first trimester of pregnancy. Therefore, planning the pregnancy carefully and consulting your epilepticologist for a possible modification of the dosage or type of drugs, becomes essential before conception. Then, once the pregnancy has begun, the safest solution is to continue the current therapy. In any case, the treating epileptologist will evaluate the risks and benefits of any decision.
The suspension of drugs when pregnancy has already begun generally does not offer advantages, on the contrary, an abrupt interruption must in any case be avoided because it is extremely dangerous. Furthermore, during pregnancy, regular monitoring of the therapy and dosages of the drugs taken must be carried out: some antiepileptics, in fact, undergo a modification of their metabolism during pregnancy and, for the same dose taken, they can be reduced in the blood, exposing the patient at additional risks of presenting crises. The specialist will then evaluate a possible increase in the dose to be taken.
At the time of birth and after childbirth
Childbirth can be carried out naturally in most cases, possibly resorting to epidural analgesia, which is recommended. In fact, a caesarean section is used only in cases where the frequency and characteristics of the mother’s crises are such as to prevent her from collaborating during labor or for gynecological reasons.
After pregnancy, the treating specialist will establish any new drug dosages, restoring the doses taken before pregnancy. Breastfeeding retains its important benefits in the babies of women taking antiepileptic drugs.
There are rare cases of acute side effects from drug exposure in breast milk, particularly sleepiness and difficulty latching onto the breast. Only in these cases is it recommended to switch to mixed breastfeeding, and only if the problem persists, to artificial breastfeeding. Since sleep deprivation is an important risk factor for seizures, during the postnatal period it is very important to ensure that family members help them to breastfeed the baby at night, allowing them to rest.
The use of a breast pump to keep your milk in the fridge for the night feeding, which can then be managed by the partner, can be a good strategy. It is also useful to have help during the day to be able to afford a few naps. Finally, it may be prudent, especially in women who are not free from seizures, to implement some precautions in the care of the child, which protects him from risks in the event of a mother’s crisis, for example bathing in the presence of another adult, preferring the wheelchair to the sash, do not share the bed.
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