Preconception counseling is necessary for women with epilepsy G, which is a common disorder among 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.
With the guidance of a physician, the vast majority of women with G epilepsy can have a normal pregnancy and delivery process; patients should be aware of the risks of G epilepsy and AEDs to pregnancy and the fetus; and patients should be aware of the need for folic acid and vitamin K supplementation.
I. Effects of seizures on pregnancy and fetus
1. 15-30% of women with G seizures have an increase in seizures during pregnancy;
2. The effects of G seizures on pregnant women: mainly increased pregnancy complications, such as vaginal bleeding, miscarriage, preterm delivery, obstructed labor and gestational hypertension syndrome;
3. The effect of G seizures on the fetus: mainly perinatal fetal complications and increased rate of neonatal malformations;
4. Poor seizure control is a risk to the fetus and to the patient.
The effect of antiepileptic drugs (AEDs) on the fetus
The effect of AEDs on the mental development of the offspring of women with G epilepsy is not known. The effect of AEDs on the intellectual development of the offspring of women with epilepsy is unknown.
III. Folic acid
The risk of neural tube abnormalities and other malformations related to folic acid metabolism is significantly higher in the fetuses of women with epilepsy who take AEDs. All women with G epilepsy should take 5 mg of folic acid daily during the first trimester before pregnancy.
IV. Vitamin K
All newborns born to women with epilepsy on AEDs should be given vitamin K 1mg 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 for pregnant women with G epilepsy during pregnancy.
1. In addition to regular obstetric check-ups, pregnant women should also see an epilepsy G specialist regularly;
2, timely adjustment of the dose of AEDs according to clinical seizures to minimize and avoid seizures, especially generalized tonic-clonic seizures;
3. If seizures are poorly controlled during pregnancy, the effects of pregnancy-related factors, such as severe vomiting and poor compliance, should be fully considered;
4. Blood concentration monitoring is mainly used to observe dose-related toxic reactions and patient compliance;
5. Detailed ultrasound examination of the fetus should be performed at 16-20 weeks of gestation to detect possible malformations in a timely manner;
6. Delivery
1. Most women with epilepsy G can deliver normally, but pain, stress, lack of sleep, hyperventilation and other factors increase the risk of seizures during labor.
2. Avoid all kinds of seizure triggering factors during delivery;
3.AEDs should be taken on time and in the right amount during and after delivery. If oral AEDs cannot be taken in time, adequate AEDs should be given through other means;
4. If frequent generalized tonic clonic seizures or prolonged partial seizures occur in the second trimester, early termination of pregnancy by cesarean section should be considered;
5. During delivery, once G seizures occur, measures should be taken as soon as possible to terminate the seizures, and diazepam or lorazepam can be used intravenously; if the seizures persist, they should be treated according to the continuous state of G seizures; at the same time, measures should be taken to end the delivery as soon as possible and to prepare for neonatal resuscitation.
VII. Postpartum advice
1, the mother and her family should know about the measures to ensure the safety of mother and child to reduce the occurrence of accidents;
2.Patients should make plans for nursing and child care before delivery, especially the safety of mother and child should be fully considered;
3. promptly adjust the patient’s treatment of AEDs after delivery;
4.Give advice on contraception.
Eight, breastfeeding advice
The vast majority of AEDs can be secreted through breast milk, but the concentration of AEDs in breast milk is relatively low. For most women taking AEDs, breastfeeding is relatively safe. The following issues need to be noted.
It is recommended not to breastfeed if taking anti-epileptic G drugs that are contraindicated during breastfeeding (e.g., carbamazepine, aminoglutethimide, etc.);
The dose of AEDs should be within the regular dose and should not be increased arbitrarily;
Pay attention to adverse reactions in infants, such as irritability, poor sleep, weight loss or sedation, decreased muscle tone, sucking weakness, and difficulty in eating.