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Women, Pregnancy, and Epilepsy

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Getting Pregnant With Epilepsy continued...

Once you become pregnant, it will be even more important to control your seizures. Having seizures during pregnancy can affect of the health of your baby. You might fall, or the baby may be deprived of oxygen during the seizure, which can injure the baby and increase your risk of miscarriage or stillbirth.

Unfortunately, some of the most common drugs for controlling seizures have been found to increase the risk of birth defects. In the general population there is a 2%-3% chance that a child will have a birth defect. In women with epilepsy, this risk goes up to 4%-8%.

To help decrease the chance of birth defects, especially neural tube defects that can affect the brain and spinal cord, women with epilepsy should take at least 0.4 milligrams per day of folic acidsupplements, before they try to conceive.

Epilepsy Drugs Safe for Pregnancy

Which epilepsy drug should you take? Unfortunately, there is no clear answer. There are no antiseizure drugs that are completely without risk of causing birth defects. But some antiseizure medications appear to be more dangerous for a developing baby than others, and your doctor may be able to avoid prescribing them. Here's what doctors know so far:

  • Depakote and Depakene seem to carry the highest risk of damage to the baby, particularly neural tube defects, such as spina bifida.
  • Doctors used to advise women to switch to phenobarbitol during pregnancy, because it appeared to be safer. Now, more recent research shows that it can also increase the risk of birth defects.
  • Tegretol, Carbatrol, and Lamictal appear to carry lower risks of birth defects than Depakote and phenobarbitol.

But that's not the whole story. Research has recently shown that women taking Lamictal have a higher risk of breakthrough seizures during pregnancy. That's because metabolism of Lamictal -- as well as other antiepileptic drugs -- increases during pregnancy. This can cause a drop in the level of antiseizure medication in your system. If that level gets too low, you could have a seizure. But if your doctor prescribes a higher dose of Lamictal to make sure that you don't have breakthrough seizures, there could be a higher risk of damage to your baby.

What makes things a bit more confusing is that information about the safety of antiseizure drugs during pregnancy is changing all the time. "This makes managing epilepsy during pregnancy very complicated," says Jacqueline French, MD, professor of neurology at New York University's Langone Medical Center and co-director of Epilepsy Research and Epilepsy Clinical Trials at the NYU Comprehensive Epilepsy Center. "It's important that women with epilepsy who want to become pregnant make sure they are seeing a doctor who keeps up to date on all the newest research. What we know about epilepsy and pregnancy literally changes from month to month." You can also check with the Epilepsy Foundation if you have questions.

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