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    Women, Epilepsy, and Sexuality

    New knowledge, new drugs open new doors for people with seizure disorders.

    Combating Birth Defects

    Though women with epilepsy were once discouraged from having babies due to the health risks of mother and fetus alike, more than nine in 10 of such women now have healthy babies. Nevertheless, there are special concerns to be faced.

    Though some women say they would rather go off their medication during pregnancy than risk hurting their fetus, doctors generally advise against this.

    "It really depends on the individual," Pack says. "Some women must continue to take their drugs or they will have a seizure, and that could be worse to both the mother and the fetus than not taking the drug. There's a risk of preterm delivery, miscarriage, and decreased oxygen to the brain that can result in permanent brain damage, even death."

    On the flip side, there is a chance that some anti-seizure drugs can cause birth defects in the newborn. And it's not a concern to be taken lightly: The anti-epileptic drug phenobarbital went on the market in 1912, but it was not until the 1990s that articles about its harmful effects on the fetus began to appear, says Lewis Holmes, MD, professor of pediatrics at Harvard Medical School and chief of the pediatric and teratology unit at Massachusetts General Hospital in Boston.

    Because some seizure medications are known to lower levels of folate, which is associated with birth defects, women of childbearing age should take folate supplements (400 mg per day) as part of a healthy diet.

    Holmes, director of the Harvard-based Antiepileptic Drug (AED) Pregnancy Registry, says his group's goal is to detail the risk of birth defects in women taking widely used anticonvulsant drugs. So far, his team has released two reports, the most recent on babies born to 149 women who took the anticonvulsant drug valproate during pregnancy.

    About 11% of the newborns developed major birth defects, including heart abnormalities, extra fingers, kidney problems, spina bifida, and clubfoot. In comparison, only 1.6% of babies born to women not exposed to any antiepileptic drug had a defect, according to the study, presented in 2003 the 23rd Annual Meeting of the Society for Maternal-Fetal Medicine.

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