Pregnancy is a time of rapid change in your body and you may experience a whole range of new sensations that you are trying to make sense of. We often field questions about epilepsy pregnancy and surprisingly, seizures in the womb.
Can babies have seizures in the womb?
It is thought that foetal seizures, or seizures in the womb, are very rare. They can have many causes and may also be associated with a poor outcome. It is reasonable to assume that a baby who has seizures in the womb will have neurological complications after birth.
There is evidence that a large proportion of neonatal neurological problems begin in the period just before childbirth. It is likely that the signs, such as seizures, of that neurological problem might also occur before birth. Whatever the specific type of neurological problem, prenatal and neonatal seizures represent important signs or predictors for assessing risk for later conditions in children, ranging from epilepsy to developmental disorders.
However, it is worth noting that reported cases of seizures in-utero are likely to represent the severe end of the spectrum, and there might be more cases of unreported or undetected in-utero seizures that have a more favourable outcome.
If you feel that the baby’s movements have changed, or either increased or decreased, it is important to speak to your obstetrician or midwife straight away. They will decide if foetal movement monitoring or ultrasound is needed to investigate further.
How can I tell the difference between movement and seizure activity?
Babies in-utero differ in their movements and levels of activity. There is no specific number of movements that are thought to be normal. During pregnancy, you need to be aware of your baby’s individual pattern of movements and don’t ignore a reduction or change in your baby’s movements, a mothers instinct is often right.
Current evidence on the topic of excessive foetal movements is quite sparse and there is no clinical guidance regarding how reporting of this symptom might relate to a foetus at risk.
If you have any excessive or changes in baby’s movements, it is best to contact your doctor or midwife and have it checked. Don’t take no for an answer if you are concerned.
Note: It is also possible that an increase in maternal anxiety may lead to increased perception of foetal activity.
Questions you may want to ask your obstetrician
- Should I have an ultrasound scan?
- When should I contact you or the midwife?
- How often should I monitor my baby’s movements, now that I have been concerned?
- Will I need to have my labour induced?
- Sometimes my baby’s movements are painful, is this common?
- Can you suggest some exercises/movements to help move the position of my baby?
- What types of movements should I expect in later pregnancy, when my baby is getting bigger?
Questions taken from http://movementsmatter.org.au/information-for-women/
What is the best epilepsy medication for pregnancy?
There is no “best” medication. The medication that works best to control your seizures is what you should consider the best for you. Different epilepsies and seizure types can respond better to certain medications.
If you are taking a medication that works best for your seizure type, then ideally it is best to remain on this medication. Your neurologist will have a conversation with you about dosage and, if there is a need to make any changes. If you are taking more than one or two medications, your neurologist may also try to wean you off additional medications if the risk is low. This should all be planned well ahead of falling pregnant.
One exception to this is sodium valproate (Epilim, Valpro). It has been found that the risk of birth defects is higher with this medication, particularly higher doses, and it is not recommended during pregnancy.
Doctors are advised that sodium valproate should not be prescribed to girls or women who are pregnant, or who may become pregnant in the future, unless they are on a pregnancy prevention programme; other anti-epileptic drugs do not work to control seizures; or if they cause unbearable side effects. However, sometimes this medication is the only one that is effective for some people. If that is the case, the neurologist will keep you on this medication and attempt to have you on the lowest dose possible. It is safer than risking seizures on another medication. This is a conversation you need to have with your neurologist.
For most women it’s best to continue treatment during pregnancy. To lessen the risks for you and your baby, your neurologist will prescribe the safest medication and dosage that’s effective for your type of seizures and monitor your blood levels throughout your pregnancy.
What if I have a seizure during pregnancy?
Many mothers who have seizures during pregnancy deliver healthy babies. However some types of seizures pose a greater threat than others. If you experience a seizure during pregnancy, report the seizure promptly to your neurologist. He or she may need to adjust your medication. If you have a seizure in the last few months of your pregnancy, your obstetrician will most likely monitor your baby more often.
What if I have a seizure during childbirth?
Seizures don’t commonly occur during labour. Most pregnant women who have epilepsy deliver their babies without complications.
If you have a seizure during labour, it might be stopped with medication injected into the vein. If the seizure is prolonged, your obstetrician would most likely perform a caesarean section.
If you have frequent seizures during your third trimester, you may have a higher chance of experiencing a seizure during delivery. Your obstetrician will most likely recommend a caesarean section to avoid the risk of seizures during delivery.
If your antiepileptic medication dose is altered for pregnancy, ask your neurologist about returning to your pre-pregnancy levels soon after delivery to continue keeping your seizures under control and your medication at safe levels. Your medication levels should be monitored during this period.
Australian Pregnancy Register (APR)
The APR is an independent research project which collects information about pregnant women with epilepsy, treated and untreated, to determine which antiepileptic medications are safest for the baby while protecting the mother from seizures.
APR is seeking women with epilepsy, or other women taking antiepileptic medications, who are pregnant or have recently given birth, to help us understand the effects of these medications on the mother and developing baby during pregnancy.
If you, in the last 20 months:
- took an antiepileptic medication during pregnancy for any reason, or
- have epilepsy and did not take medications during pregnancy, or
- took antiepileptic medications during pregnancy and experienced an alternative pregnancy outcome, or
- have epilepsy, did not take medications during pregnancy and experienced an alternative pregnancy outcome,
We would appreciate you participating in this research study and sharing your experience.
To register, click here