By: Natalie L. Boehm, MBA, RBLP-T
Pregnancy and Epilepsy
Making the decision to start a family is a big decision for anyone. For women who are battling epilepsy, it is even a bigger decision. Many things need to be taken into consideration. Seizure activity, medication side effects, and pregnancy symptoms are just a few examples of what needs to be taken into consideration. As a woman with epilepsy who has given birth twice, both of my pregnancies were planned, and both were very different.
What are the first steps?
The Center for Disease Control and Prevention provides a ten-step list of how to prepare for pregnancy. Women who are battling a chronic illness should take the proper precautions to prevent any unplanned pregnancy. When it comes to epilepsy, some anti-convulsant medication can cause complications and can result in the fetus developing cleft lip and palate, spina bifida, and other complications. If you are not planning on getting pregnant, but are sexually active, it is important to talk to your physician about what resources are available to prevent unplanned pregnancy.
The Center for Disease Control and Prevention 10 Steps for Planning a Pregnancy
Step 1: Make a Plan and Take Action
Step 2: See Your Doctor
Step 3: Take 400 Micrograms of Folic Acid Every Day
Step 4: Stop Drinking Alcohol, Smoking, and Using Certain Drugs
Step 5: Avoid Toxic Substances and Environmental Contaminants
Step 6: Reach and Maintain a Healthy Weight
Step 7: Get Help for Violence
Step 8: Learn Your Family History
Step 9: Get Mentally Healthy
Step 10: Have a Healthy Pregnancy!
(CDC, 2020)
https://www.cdc.gov/preconception/documents/Pregnancy_Planner_508.pdf
The link above is a guidance to help women who are planning a pregnancy. Making sure you are healthy not just physically, but emotionally and mentally is essential. If you are not planning a pregnancy at this point or are done having children, talk to your doctor about what options of birth control are best for you.
Seeing your doctor to discuss planning a pregnancy is important. In choosing an OB-GYN, make sure that the physician has experience with high-risk pregnancies. Also, make sure they are good communicators and are willing to communicate with your neurologist or epileptologist. You need your neurologist or epileptologist to be part of your birthing team just in case you need to make any changes to treatment during your pregnancy.
Folic acid is a B vitamin and can help to prevent any complications during pregnancy. Most complications begin in the first trimester, so it is best to start taking folic acid before trying to conceive. My OB-GYN started me on 4,000 micrograms of folic acid three months before trying to conceive. I also took prenatal vitamins as well. Anything you can do to improve your health, become stronger, and prevent complications is important for you and your baby.
Alcohol, smoking, and drug abuse lead to several unnecessary complications. Alcohol can lead to fetal alcohol syndrome, smoking can cause lower birth weight, and drug abuse, especially pain medications/opioids can lead to very painful withdrawals for the baby, many having seizures from it. If you are battling alcoholism, need help stopping smoking, or are battling drug addiction, seek help before trying to conceive.
Avoid toxic substances while you are pregnant. I was told during my pregnancy I was not allowed to clean the litter box for my cats. Certain house cleaners, bug sprays, lawn chemicals such as Round Up are all very dangerous for the fetus. The CDC link below will give you access to the specific things you should not be exposed to during pregnancy.
https://www.cdc.gov/niosh/topics/repro/pregnancy.html
Maintaining a healthy weight can be challenging for someone with epilepsy. Many side effects of anti-convulsant medication are weight gain and weight loss. Talk to your neurologist and OB-GYN about risks when it comes to weight management. The link below from John Hopkins gives you guidance on what to eat during pregnancy and what to avoid.
https://www.hopkinsmedicine.org/health/wellness-and-prevention/nutrition-during-pregnancy
Violence is something all women should avoid. Sadly, women end up in relationships that lead to domestic violence. According to the American College of Obstetricians and Gynecologists, 1 in 6 abused women is first abused during pregnancy (March of Dimes, 2021). Situations such as unplanned pregnancy, financial distress, and lack of attention can lead to partners abusing their spouses. There is no reason or excuse that justifies anyone being abused. If you are being abused, contact the National Domestic Violence Hotline at (800) 799-7233 or (800) 787-3224 (TTY) for help.
Knowing your family’s history is important. If you family has a history of a certain condition, it is best to check to see if your child is at risk. Many people have a genetic mutation and do not realize it. I did not know I was a carrier for hemophilia. I have had easy bruising and heavy bleeding my entire life and my family thought it was an effect from my medication. Both of my sons were born with severe type A hemophilia. Request from your physician genetic testing to prevent any complications.
Mental health is something our healthcare system needs to focus on more. Mental health is very important, yet with have placed a negative stigma on it. If you are not mentally healthy, you are not physically or emotionally healthy. Women with epilepsy are at higher risk for anxiety and depression so make sure to discuss with your doctor your mental health history and any changes you have report it to your doctor.
Once pregnant, do everything you can to focus on your overall wellness and prepare for childbirth. Creating a birth plan and discussing with your doctor your goals is important. Options such as having a doula present can help alleviate stress for the mother and father while going through labor. See what your options are to make your pregnancy the best it can be. Going through pregnancy is a journey enough but battling epilepsy at the same time can bring a lot of stress and you need to take care of yourself. Make sure to follow proper guidelines and educate yourself as you get ready to bring a new life into this world.
Resources:
Centers for Disease Control and Prevention (2020). Planning for Pregnancy. Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/preconception/planning.html
Centers for Disease Control and Prevention (2019). Reproductive Health and the Workplace. Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/niosh/topics/repro/pregnancy.html
John Hopkins Medicine (2021). Nutrition During Pregnancy. John Hopkins Medicine. Retrieved from: https://www.hopkinsmedicine.org/health/wellness-and-prevention/nutrition-during-pregnancy
March of Dimes (2021). Abuse During Pregnancy. March of Dimes. Retrieved from: https://www.marchofdimes.org/pregnancy/abuse-during-pregnancy.aspx
