The most important concern for women with epilepsy and their families is the issue of childbirth, which is also a tricky issue for doctors and difficult to answer with a simple yes or no. It is also common for patients who are 1-2 months pregnant to come in for advice on medication. The following is quoted from the China Epilepsy Treatment Guidelines in the hope of giving some guidance to patients, but most importantly, to plan to have children under the guidance of a doctor.
Due to the special physiological characteristics of female patients with G epilepsy, treatment measures should take full account of reproduction, pregnancy, childbirth and other aspects of the situation.
I. Puberty and epilepsy G
Adolescence is one of the high incidence periods for female G epilepsy.
It is necessary to re-evaluate the diagnosis and the type of seizure in diagnosed patients entering adolescence to ensure the most effective treatment plan.
Treatment regimens should take full account of patient compliance, sensitivity to certain adverse effects of AEDs, and the impact on fertility.
II. Fertility
Emphasis on the reproductive function of women with G epilepsy is one of the most important aspects of improving the quality of life of patients.
Control of seizures in G.
Medications that may affect reproductive function, such as valproate, should be avoided in patients who have not yet had children.
l Advise patients who are planning to have children to plan their pregnancy under the guidance of a physician.
III. Contraception
Contraception is a common problem for women with childbearing epilepsy, and it is necessary to give advice to patients about contraception. Women with epilepsy who take enzyme-induced AEDs have a significantly higher chance of failing to take oral contraceptives. Non-enzyme-inducible AEDs have no effect on oral contraceptives. Enzyme-induced AEDs include: carbamazepine, oxcarbazepine, phenobarbital, paracetamol, topiramate; non-enzyme-induced AEDs include: benzodiazepines, acetazolamide, ethosuximide, gabapentin, lamotrigine, levetiracetam, tiagabine, valproic acid, aminoglutethimide.
(i) Compounded oral contraceptives
(b) When patients are taking oral contraceptives, it is more appropriate to apply non-enzyme-inducing AEDs.
Patients taking enzyme-inducing AEDs are advised to use contraceptive methods such as condoms to achieve optimal contraceptive effect.
l If compounded oral contraceptives are used in conjunction with enzyme-inducing AEDs, the minimum dose of estradiol should be 50 micrograms per day; if breakthrough bleeding occurs, the dose of estradiol should be increased to 75 to 100 micrograms per day.
(ii) Progesterone single contraceptive pill
(i) Oral progesterone monocontraceptive is not recommended for patients taking enzyme-induced AEDs.
(iii) Injectable long-acting progesterone may be applied in patients taking enzyme-inducible AEDs, but must be injected every 10 weeks.
Patients taking enzyme-induced AEDs should not apply progesterone implant tablets.
(iii) Emergency contraception: Patients taking enzyme-induced AEDs should take 1.5 mg first and then 750 mcg 12 hours later when taking levoprogesterone for emergency contraception.
IV. Preconception counseling
Epilepsy G is a common disorder in women in their reproductive years, and pregnancy in women with epilepsy G may increase the risk of seizures, various complications, and malformations in the offspring, necessitating preconception counseling for women with epilepsy G.
With medical guidance, the vast majority of women with G epilepsy can have a normal pregnancy and delivery process.
Informing patients of the risks of epilepsy G and AEDs for pregnancy and fetus.
Informing patients of the need for folic acid and vitamin K supplementation.
(i) Effects of seizure G on pregnancy and fetus
(b) 15-30% of women with G epilepsy have increased seizures during pregnancy.
(b) Effects of G seizures on pregnant women: mainly increased pregnancy complications, such as vaginal bleeding, miscarriage, preterm delivery, obstructed labour and gestational hypertensive syndrome.
Effects of G seizures on the fetus: mainly increased perinatal fetal comorbidities and neonatal malformations
Inform patients of the risks of poor seizure control to the fetus and to themselves.
(ii) Effects of AEDs on the fetus
In the normal population, the fetal malformation rate is 2-3%. The malformation rate increases 2-3 times in the offspring of women with G epilepsy taking single AEDs, and is higher in the offspring of women with G epilepsy taking multiple AEDs. The effect of AEDs on the mental development of the offspring of women with G epilepsy is unknown. There is insufficient evidence to assess the teratogenicity of the new AEDs (gabapentin, levetiracetam, tiagabine, topiramate, and aminoglutethimide).
Before a woman with G epilepsy is ready to conceive, her treatment history should be reviewed and she should be informed of the effects of G seizures and AEDs on the pregnancy and fetus.
Patients whose seizures have been controlled prior to conception and who are at low risk of recurrence may be considered for pregnancy after discontinuation of AEDs, provided they are informed of the effects of G recurrence on the pregnancy and fetus.
If the patient requires the application of AEDs for seizure control during pregnancy, the risk of seizures and fetal malformations needs to be fully communicated with the patient and family.
If the patient needs to apply AEDs to control seizures during pregnancy, single-drug low-dose therapy should be chosen as much as possible according to the type of seizure and multi-drug combination therapy should be avoided as much as possible
If the patient has already given birth to a malformed child, she should consult an epilepsy G specialist before becoming pregnant again.
(iii) Folic acid
Female epilepsy G patients taking AEDs have a significantly higher risk of fetal neural tube abnormalities and other malformations related to folic acid metabolism. All women with G epilepsy should take 5 mg of folic acid daily for the first trimester before conception.
(iv) Vitamin K
All newborns delivered by women with epilepsy G taking AEDs should be given vitamin K 1 mg intramuscularly after birth.
If a newborn delivered by a woman with G epilepsy has other risk factors for bleeding disorders (e.g., pregnant mother with liver disease, expected preterm infant, etc.), the pregnant woman should take vitamin K 10 mg orally daily during the last month of pregnancy.
V. Pregnancy: Special attention should be paid to the following aspects during pregnancy for pregnant women with G epilepsy.
Pregnant women should be seen regularly by an epilepsy G specialist in addition to regular obstetric examinations.
Timely dose adjustment of AEDs according to clinical seizures to minimize and avoid seizures, especially generalized tonic-clonic seizures.
If seizures are poorly controlled during pregnancy, the effects of pregnancy-related factors, such as violent vomiting and poor compliance, should be fully considered.
Blood level monitoring primarily to observe dose-related toxic reactions and patient compliance.
Detailed ultrasound of the fetus should be performed at 16-20 weeks of gestation for timely detection of possible malformations