Anti-Epileptic Drugs and Pregnancy

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Working closely with your doctor throughout planning for your pregnancy, the progress of your pregnancy, and after childbirth can help to gain the best possible outcome for the health and wellbeing of yourself and your baby.

It is very important not to change or stop your AED treatment without the consultation of your doctor or specialist.

The impact of anti-epileptic drugs (AEDs) on a woman’s health, and that of their unborn baby, is often a great concern to women living with epilepsy. This concern is reflected in the significant amount of research in the area.

Balancing seizure control throughout pregnancy with the impact of AEDs on the physical and neurological development of the foetus is an issue regularly faced by women living with epilepsy who are considering pregnancy.

AEDs and seizure control in pregnancy

If you are taking AEDs and you are pregnant one key issue you may face is the impact of your pregnancy on your level of seizure control. This impact affects each pregnant woman with epilepsy differently. Some women experience an increased number of seizures during their pregnancy while other women experience a reduction in the frequency of their seizures. Some women only experience seizures during pregnancy, whilst some see no change in their level of seizure control.

Some factors related to your AED treatment that may affect your level of seizure control during pregnancy include:

  • Sleep deprivation
  • Changes in the way AEDs are absorbed and work in the body
  • Weight gain
  • Changes in your metabolism
  • Vomiting

Impact of AEDs on the foetus

If you are a pregnant woman with epilepsy, or someone planning for a pregnancy, you may be concerned about the impact of AED treatment on your unborn baby. There is a significant amount of research into the effects of AEDs on the foetus, so your doctor will be well aware of the risks associated with each AED. Some recent findings from research in this area include:

  • Women on AEDs are at a slightly higher risk (4-6%) of having babies with congenital malformation and birth defects than the rest of the population (2-3%).
  • Some AEDs carry a higher risk of congenital malformation and birth defects than others.  Dosage of certain AEDs can also play a role in determining this risk.
  • There have not been significant findings to suggest an association between AED treatment for pregnant women with epilepsy and an increased likelihood of spontaneous abortion or stillbirth, however, research in this area is limited and further studies are developing.
  • Valproate (Epilim, Valprease, Valpro) is the AED that contributes to the highest risk of congenital malformation and birth defects such as spina bifida. This risk changes according to the dose the woman is taking.
  • Various studies suggest that other AEDs such as Carbamazepine (Tegretol, Teril), Lamotrigine (Lamictal, Lamidus, Logem, Reedos), Phenytoin (Dilantin) and Topiramate (Epiramax, Tamate, Topamax) may slightly increase the risk of congenital malformations, but not to the extent that Valproate does.
  • Taking a 5mg dose of folic acid as directed by your doctor may help protect against AED-related congenital malformations.
  • If you are taking AEDs, the foetus is at most risk of developing congenital malformations during the first trimester of pregnancy.

What kinds of congenital malformations and birth defects can occur?

Valproate has been linked to neural tube defects such as spina bifida, however, there is little evidence to suggest a connection between any other AED and specific congenital malformations or birth defects. The other most common defects to occur include cardio respiratory problems such as bulbus cordis, cleft palate, urogenital defects such as hypospadias, and having extra fingers or toes.

Management of AEDs during pregnancy

It might seem overwhelming for you to consider the risks associated with AED use in pregnancy. You are not alone, it is normal to feel worried about the wellbeing of your baby. However, it is important to note that most women (93%) with epilepsy experience successful pregnancies and have healthy babies. The best way to increase the chance of a healthy pregnancy is by planning your pregnancy with the guidance of your doctor well in advance to conception.

Some important steps to consider if you are planning pregnancy or become pregnant:

  • Do not stop taking your AEDs without the guidance of your doctor or neurologist.  Doing so could increase the severity and how often you have seizures, which could be harmful to you and your unborn baby. Your doctor may request changes to your medication during pregnancy to protect the baby from any possible harm.
  • Organise a consultation with your doctor or specialists as soon as you decide to consider pregnancy. Discuss the following at the appointment:

    –  Your current level of seizure control
    –  Your current AED treatment and if changes are needed prior to becoming pregnant
    –  The appropriate amount of folic acid intake prior to conception, you may need to take a higher level of folic acid for a longer period of time before conception than normal
    –  Any risks associated with your course of AED treatment and management strategies for this

  • If you experience an unplanned pregnancy, organise an urgent appointment with your doctor to discuss your options. See our information sheet on unplanned pregnancy
    for more details.
  • Try to stay in good health if you are pregnant and are taking AEDs to promote your wellbeing and that of your baby, and to stay in control of your seizures. Some considerations to manage your health include:

    –  Be aware of your seizure triggers and working to avoid them by getting plenty of sleep and using coping
    strategies for any stress you may be feeling
    –  Take your AEDs as instructed by your doctor to stay in control of your seizures as much as possible
    –  Eat a healthy diet to prevent excessive weight gain which can affect the way your AEDs are absorbed

Managing the risks between your AED treatment, seizure control and a healthy pregnancy can feel overwhelming and stressful. Keep in mind that there are many supports available to you through your doctor or specialist, organisations like the Epilepsy Foundation, and the Australian Pregnancy Register.

Remember, you have a high likelihood of experiencing a healthy pregnancy and having a healthy baby, especially if you plan in advance for conception and work with your doctor or specialist to achieve the best outcome.

Other resources

The Australian Pregnancy Register for Women on Antiepileptic Drugs can enrol you on their register if you are interested in participating in research about these issues
Contact 1800 069 772
http://www.neuroscience.org.au/australian-epilepsypregnancy-register

Other helpful information about epilepsy, pregnancy, contraception and anti-epileptic drugs can be found on our website www.epilepsyfoundation.org.au. For more information and further resources contact our Information Line on 1300 761 587.

References

Bech, B H, Kjaersgaard, M I S, Pederson, S P, Howards, P P, Sørensen, M J, Olsen, J, Parner, E T, Pederson, L J, Vestergaard, M & Christensen, J 2014, ‘Use of antiepileptic drugs during pregnancy and risk of spontaneous abortion and stillbirth: population based cohort study’, The British Medical Journal, doi: 10.1136/bmj.g5159

Vajda, F J E 2014, ‘Effect of anti-epileptic drug therapy on the unborn child’, Journal of Clinical Neuroscience, vol. 21, no. 4, pp. 716-721.

Vajda, F J E & Eadie, M J 2016, Antiepileptic drugs and pregnancy: A guide for prescribers, Adis, Heidelberg. Vajda, F J E, O’Brien, T, Lander, C, Graham, J & Eadie M 2014,’Is carbamazepine a human teratogen?’, Journal of Clinical Neuroscience, vol. 23, pp. 34-37.

Vajda, F J E, O’Brien, T, Lander, C, Graham, J & Eadie M 2014,’The efficacy of the newer antiepileptic drugs in controlling seizures in pregnancy’, Epilepsia, vol. 55, no. 8, pp. 1229-1234.

 

© Epilepsy Foundation August 2017. The information contained on this p provides general information about epilepsy. It does not provide specific advice. Specific health and medical advice should always be obtained from a qualified health professional.