Health Tips

(This is Part 2 of the previous article)

As we mentioned in part 1, epilepsy and its treatment can affect women differently. We discussed its effects on fertility, menstruation and contraception in the previous article.

Planning for pregnancy

Many anti-epileptic medications increase the risk of both major and minor birth defects in babies, with some types carrying a higher risk than the others. For example, a 2019 report from the International League Against Epilepsy (ILAE) concluded that sodium valproate is associated with the highest risk of major congenital malformations (called teratogenic), while phenobarbital and topiramate are associated with an intermediate risk, and lamotrigine and levetiracetam are associated with the lowest risk. The more antiepileptic medications a woman takes, the higher the likelihood of birth defects. The resulting birth defects include malformations in the neural tube, congenital heart,  urinary tract defects, skeletal abnormalities, and oral clefts. 

Baby with cleft lip. Image from: https://www.cdc.gov/ncbddd/birthdefects/cleftlip.html

For these reasons, women with childbrearing potential are advised against getting pregnant until they become seizure-free for more than 2 years and eligible to stop taking anti-epileptic medications. However, for various personal, cultural or religious reasons, this is seldom possible or practical. Therefore, women who wish to plan for pregnancy should always have discussions with their doctors regarding the risk of birth defects and the seizure control associated with their epilepsy treatment. The harmful effects of anti-epileptic treatment on babies usually occur in the first trimester, so changing to a less teratogenic anti-epileptic medication should take place before getting pregnant.

Do not stop taking your anti-epileptic medications without consulting your doctor first because it might increase the chances of developing seizure. 

Receiving epilepsy treatment during pregnancy and labour

Photo by Anastasiia Chepinska on Unsplash

It can be tricky to manage epilepsy during pregnancy. Not only for the reason we mentioned above, but one third of women with epilepsy reported the frequency of seizure increases during pregnancy. The possible reasons are poor compliance to anti-epileptic medication and changes in anti-epileptic medication pharmacokinetics, i.e. pregnancy can change how the medications work inside the body. As a result, the efficacy of anti-epileptic medication may be reduced due to pregnancy. This is why if you have epilepsy and are pregnant, the doctor may take your blood samples to monitor the levels of anti-epileptic medications in your blood. This is to make sure the level is high enough to suppress seizures but not too high to cause toxicity. Your doctor may also prescribe you with supplements such as folic acid and vitamin K to reduce the risk of birth defects.

Similarly, you should not stop receiving anti-epileptic treatment during pregnancy unless your doctor told you to. Epilepsy that takes place during pregnancy can lead to various complications, such as preeclampsia (high blood pressure and organ damage), preterm labor, prematurity and foetal death. If you worry about the harmful effects of anti-epileptic medications can have on your baby, discuss with your doctor.

Breastfeeding

Breastfeeding for most women receiving anti-epileptic medication is generally safe. If the dose of medication was increased during your pregnancy, your doctor would usually reduce the dose to the amount you were taking before pregnancy to allow you safely breastfeed your baby. 

As different anti-epileptic medications have different properties, they may present in variable amounts in breast milk too. For example, gabapentin and levetiracetam can have equal concentrations in both the mother’s blood and breast milk (in other words, concentration is relatively higher than other anti-epileptic medications); on the other hand, phenytoin and sodium valproate present have very low concentrations in the breast milk because they mostly bind to the protein molecules in the mother’s blood. If you’re worried about exposing your baby to anti-epileptic medication secreted in breast milk, even in very low quantities, you may reduce frequencies of breastfeeding or supplement with bottle feeding. You’re also advised to breastfeed your babies whilst seated on floor cushions and should not be allowed to bathe the babies in a bathtub unless assisted to avoid dropping the babies in case a seizure occurs.

Bone health

Photo by Nino Liverani on Unsplash

Anti-epileptic medications may also affect your bone health. Remember we mentioned enzyme-inducing anti-epileptic medications that reduce efficacy of oral contraceptive pills in Part 1? They are:

• Carbamazepine (Tegretol)

• Phenytoin (Dilantin)

• Phenobarbital

• Primidone (Mysoline)

• Oxcarbazepine (Trileptal)

• Topiramate (Topamax)

Well, this group of anti-epileptic medications and also sodium valproate can affect the metabolism of oestrogen, which is a hormone that is crucial to healthy bones. As a result, they can increase the risk of bone diseases such as osteopenia and osteoporosis. Phenytoin, a common anti-epileptic medication, also known to reduce the absorption of calcium, thus giving rise to weaker bones. It’s recommended that people who take these medications for more than five years should undergo bone health screening (called bone mass densitometry) and receive calcium and vitamin D supplementation for stronger bones. Weight-bearing exercises, adequate sunlight exposure, cessation of smoking, and avoidance of caffeine should be encouraged. If metabolic bone diseases such as osteoporosis is diagnosed, it should be treated accordingly. 

A word from DOC2US

If you have any questions related to epilepsy, you can consult our professional doctors and healthcare professionals on DOC2US. DOC2US is a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere. For better communication, you can even send our online doctor images or voice messages related to your medical inquiry.

Download DOC2US app on Apple App Store, Google Play Store and Huawei App Gallery; or use our web chat at https://web.doc2us.com/

Note: DOC2US is not for medical emergencies. In the event of urgent medical conditions, please call 999.

Disclaimer: As a service to our users and general public, DOC2US provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Specific references have been linked in its relevant part of the article. 

References

1. The Epilepsy Council, Malaysian Society of Neurosciences - Consensus Guidelines on the Management of Epilepsy 2017 (3rd edition)

2. American Family Physician - Epilepsy in Women 2002

Cover image credit: Image by Jefty Matricio from Pixabay 

Written by

Ms Joyce Toh