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How This Neurological Disorder Affects Pregnant Women

International Epilepsy Day 2021: The treatment of pregnant women with epilepsy (WWE) taking anti-epileptic drugs (AEDs) is always difficult. Fortunately, it is seen that more than 90 per cent of WWE deliver normal babies without any complications. There is no scientific data available to discourage pregnancy for WWE. Also Read – Umar Akmal Suffered From Epilepsy And Refused Medication: Former PCB Chief

With proper planning of the time of pregnancy, pre-pregnancy counselling, regular follow-ups, appropriate screening and planning delivery in a centre with intensive care facilities for both the mother and the neonate, WWE can generally look forward to an uneventful pregnancy and give birth to normal child. Also Read – Epilepsy: Know The Risk Factors to Keep The Neurological Disease at Bay

Epilepsy during pregnancy can be deleterious to both the mother and the foetus. Seizures during pregnancy in known to cause foetal growth restriction, precipitate premature labour, foetal hypoxia or even foetal death.

It is seen that about 40 per cent of WWE have unplanned pregnancy.

A planned pregnancy under the guidance of a neurologist and an obstetrician is a must for WWE. Barrier contraception or intrauterine device should be the preferred contraception. During the pre-pregnancy counselling, the neurologist can re-evaluate WWE and correct the diagnosis if there are concerns about a wrong diagnosis. Accurate diagnosis helps initiate the preferred AED for the epilepsy type which is the cardinal factor that determines seizure control.

Pregnancy is associated with physiological changes in hormonal levels in the mother. This causes altered metabolism of the administered AEDs with resultant low levels of AEDs in the blood which can trigger a seizure. So, constant monitoring of drug level is recommended during pregnancy.

The golden rules to be followed while choosing AEDs for these patients are (i) to choose the safest drug (ii) reduce the number of AEDs, preferably to a single drug and (iii) to prescribe the smallest dose to obtain optimal seizure control.

Valproate is a drug that needs to be stopped well ahead of the pregnancy as this drug is notorious to produce congenital malformations in the foetus. Studies have shown that the incidence of foetal malformation was higher in mothers on multiple AEDs during pregnancy.

Folic acid administration needs to start much before the planned pregnancy. Folic acid administration is believed to reduce the incidence of development of congenital neural tube defects. It is also seen in studies that the mean IQ of kids born to mothers who were on folic acid was higher than the kids born to mothers who were not on folic acid.

Periodic follow ups and antenatal screening is a must for these patients to ensure safe pregnancy. This includes monitoring drug levels of AEDs, determination serum alpha fetoprotein and foetal sonogram to detect anomalies at regular intervals in consultation with the treating doctors.

The delivery should be planned in a centre with adult and neonatal intensive care facilities to ensure efficient management of any unfavourable circumstances that may arise during or after delivery.

Even though some of the AEDs can be transferred from the mother to the child through breast milk, the concentration of these drugs in the breast milk is extremely low. Hence all mothers should be encouraged to breast feed. It is seen that children of mothers who were on AEDs who were breast fed did better than those who were not breast fed.

The principle to be followed while managing pregnancy in WWE is to strike a balance between control of epilepsy in the mother and prevention of development of adverse drug events in the child by carefully tweaking the AED dosage by an experienced neurologist.

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