Epilepsy is a very widespread chronic disease, around 50 million people are affected worldwide. Epilepsy is a neurological disorder characterized by unprovoked, recurrent seizures.¹ In the United States, more than half a million women that are able to conceive are diagnosed. It is a disease that need thorough care and treatment.

Fertility

It is indicated that women with epilepsy (WWE) have 20-40% lower birth rate than the rest of the population. The reason for low fertility could be the disease itself, but for the most part it is because of the treatment given. Different types of Antiepileptic drugs (AEDs) can affect the gene expression which can result in deformities like autism. To lower the risk of malformation, polytherapy is avoided and a required dose of AED with folic acid is proposed. WWE taking AEDs during pregnancy can lead to the child being born with lower IQ level.²

During pregnancy and delivery

During pregnancy, a woman’s body undergoes a lot of changes like increased cardiac output which can change the AED levels leading to frequent seizures.³ There is a low risk of seizures happening during pregnancy. WWE are not always required to go for C-section delivery but usually recommended vaginal delivery. If the mother has risk of high frequency seizure, only then c section along with epidural anesthesia is recommended. However, the pregnancy is still considered dangerous.⁴

Effect on the fetus

There could be a few complications like stillbirth during labor but most of the time they are born completely healthy. In certain studies, WWE have shown to also have an increased rate of premature delivery which is mainly because of the high exposure to AEDs. The fetus is also at a high risk of abnormalities thus ultrasonography is recommended.⁴

Breastfeeding

Breastfeeding is essential for a child’s growth and immunity and plays a positive role in postpartum depression. However, studies show a low number of WWE breastfeeding because of the misconception that the Breast milk contains AEDs taken by the mother during her pregnancy. Breastfeeding should be encouraged if the mothers were consuming monotherapy during their pregnancy.

Conclusion

WWE can have successful pregnancies if appropriate measures are taken. Antiseizure medications that have the lowest risk of deformities should be taken. Changes in AEDs should always be monitored. lactation should also be encouraged as it helps the infant and their IQ levels. To achieve the best treatment a competent clinician should be consulted.⁵