1. Do women with epilepsy have low fertility? The fertility of women with epilepsy is basically the same as that of the general population. 2. Why are some women with epilepsy less likely to get pregnant? (1) Seizures interfere with the hypothalamic-pituitary-gonadal axis of the endocrine system in the body, resulting in disruption of the menstrual cycle and abnormal secretion of sex hormones. (2) Anti-epileptic drugs such as sodium valproate and carbamazepine can increase body weight, and weight gain is also an important risk factor for pregnancy. Therefore, patients taking these drugs can exercise appropriately and control their diet. (3) Women with epilepsy during their childbearing years face a lot of stress and have a significantly increased risk of depression. The quality of life of depressed patients decreases and affects ovulation leading to infertility. 3. Do seizures increase after pregnancy? Most studies suggest an increase in seizures in 8% to 46% and a decrease in seizures in 4% to 24%. The risk of increased seizures is highest in the first trimester of pregnancy. About 5% have seizures at delivery. Possible reasons for worsening seizures are decreased blood levels of antiepileptic drugs, lack of sleep, and self-medication withdrawal due to fear of side effects. The concentration of antiepileptic drugs decreases during pregnancy and returns to pre-pregnancy levels in the first month after delivery. The absorption of antiepileptic drugs is affected by slow gastric emptying, nausea, and vomiting, especially during the first trimester of pregnancy. During pregnancy, blood volume increases by 5%, cardiac output increases by 30%, intravascular and extracellular fluid increases, and body fluids increase so that the concentration of antiepileptic drugs decreases. Liver detoxification increases during pregnancy, and renal excretion also increases, so that the concentration of antiepileptic drugs during pregnancy also tends to decrease. 4. Do hormonal changes in the body during pregnancy have an effect on seizures? The level of estrogen and progesterone increases significantly during pregnancy. Estrogen has a seizure-inducing effect, and progesterone has an anti-seizure effect. (Seizures often increase during menstruation due to hormonal changes as well). 5. The effect of antiepileptic drugs on contraception? Contraceptive failure confuses many women with epilepsy. Phenobarbital, paracetamol, topiramate, phenytoin, carbamazepine these antiepileptic drugs are liver enzyme inducers, can increase the metabolism of contraceptives, resulting in contraceptive failure. Sodium valproate, aminocaproic acid, gabapentin, lamotrigine, levetiracetam these non-enzyme-inducing antiepileptic drugs, will not affect the effect of oral contraceptive drugs, in the contraceptive period is safer to use. 6. Can epilepsy and anti-epileptic drugs cause fetal malformations? It has been confirmed that congenital malformations in children born to mothers with epilepsy are about 2 to 3 times higher than in children born to mothers without epilepsy. Infants can have severe or mild malformations of the orofacial, cardiovascular, and skeletal systems, and their risk of orofacial clefting is 4 to 11 times higher than that of infants born to non-epileptic mothers. Anti-epileptic drugs such as carbamazepine, lamotrigine and valproic acid have been reported to be teratogenic, which may be related to anti-epileptic drugs causing chromosomal mutations or interfering with folic acid metabolism, resulting in impaired deoxyribonucleic acid synthesis in pregnant women. If you take sodium valproate to prepare for pregnancy before you must replace other drugs, such as taking carbamazepine, lamotrigine and other drugs, 3 months before preparing for pregnancy need to take folic acid morning and evening 2, 5mg, vitamin B1 3 times a day, each time a capsule, has been taken until 3 months after pregnancy can be discontinued. 7. What are the effects of seizures on the fetus? If the seizures are frequent during early pregnancy, the blood oxygen will be reduced, which may affect the development of embryonic differentiation and lead to malformation or even miscarriage. Seizures during mid- and late pregnancy may result in intrauterine growth retardation, low weight, intrauterine distress, and cognitive dysfunction and developmental delay in newborns or preschool children. 8. Can epileptic patients breastfeed? Breastfeeding is an issue of concern for all mothers with epilepsy. Antiepileptic drugs generally diffuse into breast milk in a simple diffusion manner, related to the molecular weight of the drug, protein binding rate, and lipid solubility. The concentration of antiepileptic drugs in breast milk is generally very low. Levetiracetam is secreted into breast milk at high levels, so breastfeeding should be discontinued if adverse reactions are observed in children. 9. How is epilepsy treated in women during childbirth? Women with epilepsy during childbirth face a difficult choice: to discontinue or continue treatment with antiepileptic drugs. The risks to the fetus and mother from recurrent seizures have been shown to be much greater than the adverse effects of antiepileptic drugs on the mother and baby. Therefore, choosing the best individualized treatment regimen before childbirth is an important component of epilepsy treatment for women in the reproductive years. Guidelines recommend minimal doses of single agents for effective control of epilepsy. Patients who are already well controlled on low to moderate doses of monotherapy need to be maintained, and those on polypharmacy or high-dose monotherapy should be adjusted to reduce the amount of antiepileptic drugs in the first 6 months of pregnancy if possible.