Get rid of epilepsy anxiety, a health guide for epilepsy patients from pregnancy preparation to childbirth

Author: Zhao Yanan, The First Affiliated Hospital of Zhengzhou University

Reviewer: Deng Wenjing, Chief Physician, First Affiliated Hospital of Zhengzhou University

For women of childbearing age with epilepsy, the process of preparing for pregnancy, pregnancy, and childbirth can be full of anxiety and uncertainty. Epileptic seizures, drug safety, and possible effects on the fetus often make future parents feel at a loss. However, advances in modern medicine have provided epilepsy patients with a scientific and safe way to have children. Through a reasonable pregnancy preparation plan, personalized drug management, and regular prenatal care, epilepsy patients can have a safe and healthy pregnancy and childbirth experience. This article will give you a detailed introduction to the precautions for each key link from pregnancy preparation to childbirth, helping you to relieve your worries and welcome the arrival of a new life in a scientific way.

1. Precautions during pregnancy preparation

(1) Conduct prenatal consultation to clarify whether epilepsy is hereditary: Some epilepsy has a clear genetic tendency, including patients suffering from hereditary epilepsy or epilepsy secondary to a hereditary disease. The incidence of hereditary epilepsy in the next generation varies depending on the pathogenic gene and the inheritance mode. Whether secondary epilepsy is hereditary depends on the genetic probability of the primary disease.

(2) Adjust anti-epileptic medication: If the patient's epilepsy control is unstable and the seizures are frequent, pregnancy poses a great risk to both the mother and the fetus and needs to be carefully considered; patients with stable epilepsy seizure control should consult a neurologist to determine whether the medication is suitable for pregnancy. The most appropriate and lowest dose of anti-epileptic drugs should be used during pregnancy, and valproic acid should be avoided because it has a high teratogenicity. Some patients experience more epileptic seizures during pregnancy, so do not stop taking the medication on your own.

Figure 1 Copyright image, no permission to reprint

(3) Folic acid supplementation: Female patients taking anti-epileptic drugs have a significantly increased risk of fetal neural tube defects and other malformations related to folic acid metabolism. Therefore, they should take 2.5 to 5 mg of folic acid daily for 3 months before and after conception to reduce or avoid fetal malformations.

2. Precautions during pregnancy

(1) Regular prenatal check-ups: Women with epilepsy should have regular prenatal check-ups after becoming pregnant. It is recommended that they go to a high-quality ultrasound center for the check-ups.

(2) Take medication as directed by the doctor: Anti-epileptic drugs should be taken as directed by the doctor during pregnancy. Do not reduce or stop the medication on your own. The impact of epileptic seizures during pregnancy on pregnant women and fetuses is far greater than the adverse reactions of anti-epileptic drugs. Closely monitor the frequency of epileptic seizures and adjust the drug dosage appropriately. Blood drug concentrations usually decrease within 10 weeks of pregnancy due to factors such as slowed gastrointestinal motility, malabsorption and vomiting, and increased plasma flux. For patients with daily non-convulsive epilepsy and weekly generalized tonic-clonic seizures, the dose of anti-epileptic drugs can be increased as appropriate in the last 3 months of pregnancy to prevent seizures during delivery.

(3) Timely supplementation of vitamin K: The use of transaminase-inducing antiepileptic drugs (such as phenobarbital) can interfere with vitamin K metabolism and cause coagulation disorders, increasing the risk of neonatal hemorrhagic diseases. Vitamin K supplementation should be given in the last month of pregnancy and to newborns.

(4) Lifestyle adjustments: Keep a good mood, eat a healthy diet, avoid irritating foods, and avoid fatigue and emotional excitement.

3. Precautions for childbirth

(1) Choose a suitable hospital: Choose a comprehensive hospital with a neurology department and an obstetric unit with maternal and child rescue measures for delivery. If an epileptic seizure occurs during delivery, a cesarean section should be performed immediately.

(2) Avoid the risk of epilepsy: Hyperventilation, lack of sleep, pain, emotional stress, and fatigue during delivery can increase the risk of epileptic seizures. Pregnant women should avoid the above factors.

(3) Continue to take anti-epileptic drugs: Anti-epileptic drugs should continue to be taken during delivery and the postpartum period, and the effective dose of anti-epileptic drugs should be re-evaluated after delivery.

(4) Breastfeeding: All female patients with epilepsy are encouraged to breastfeed. All currently available anti-epileptic drugs can be taken while breastfeeding. If the mother is taking phenobarbital and the newborn becomes drowsy, breastfeeding and bottle feeding should be alternated.

Figure 2 Copyright image, no permission to reprint

Although epilepsy may bring challenges to pregnancy preparation, pregnancy and childbirth, through close cooperation with doctors and scientific health management, epilepsy patients can also safely and smoothly welcome the arrival of new life. I hope every expectant mother can be at ease and welcome her own healthy and happy moment.