Pregnancy booklet cover 1/19/07 3:55 PM Page c1 PREGNANCY &Epilepsy Information for Women Pregnancy & Epilepsy Pregnancy booklet inside 1/19/07 3:53 PM Page c2 ENROLL IN A PREGNANCY REGISTRY The only way to learn more about the safety of specific antiepilepsy drugs during pregnancy is through the participation of women like you. Registries for antiepileptic medications are based in the United States and abroad. North American Antiepileptic Drug (AED) Pregnancy Registry www.massgeneral.org/aed W (888) 233-2334 ep (All antiepileptic drugs) Australian Pregnancy Registry www.epinet.org.au/info/pregnancy.html 011 61 3 92883560 (All antiepileptic drugs) European & International Registry of Antiepileptic Drugs in Pregnancy (EURAP) www.eurap.org (All antiepileptic drugs) Gabapentin (Neurontin) Pregnancy Registry (617) 638-7751 (Neurontin only) Lamotrigine (Lamictal) Pregnancy Registry www.lamictal.com/epilepsy/hcp/efficacy/registry.html (800) 336-2176 (Lamictal only) The Epilepsy Foundation expresses its thanks to the authors of this pamphlet: Mark S. Yerby, M.D., M.P.H. qu North Pacific Epilepsy Research 9427 SW Barnes Road, Suite #595 is Portland, Oregon 97225 (503) 291-5300 Ge Susan Lannon, R.N., B.S. Univeristy of North Carolina pr Department of Neurology Chapel Hill, North Carolina 27599-7025 90 (919) 966-5547 ep Robert Mittendorf, M.D., Dr.PH Director of Health Services m Department of Obstetrics and Gynecology in University of Chicago Chicago, Illinois 60637 an Patricia L. Collins, M.D., Ph.D. pr This pamphlet used with permission by the authors: Mark S. Yerby, M.D., M.P.H., Susan Lannon, R.N., B.S., Th and Robert Mittendorf, M.D., Dr. PH. We would like to honor the contributions made by our late collaborator th Patricia Collins, M.D., Ph.D. ep © 2006 Epilepsy Foundation of America, Inc., Landover, to MD. This information is presented as a service of the Epilepsy Foundation. Medical knowledge changes ph rapidly and you should consult your medical practitioner for more recent or detailed information. This informa- tion is not medical advice. Do not change your medica- tions as a result of this information without obtaining medical advice about your specific circumstance. Pregnancy booklet inside 1/19/07 3:53 PM Page 1 Pregnancy & Epilepsy fic tes omen who have epilepsy have special concerns when they decide to have a Wbaby. They wonder if epilepsy or anti- epileptic medication can affect their pregnancy or their unborn child. These concerns are important ones and are also shared by the medical profession. Studies which are being conducted in the area of pregnancy and l epilepsy have helped to establish some guidelines for women with epilepsy. Many questions remain unanswered, however, and this is why continued research is so important. Generally speaking, having epilepsy should not prevent a woman from planning a family. Over 90 percent of the babies born to women with epilepsy are normal and healthy. This percentage might be even higher if the pregnancy is planned in advance with the consultation of a neurologist, and then accompanied by early and ongoing prenatal care. 1 , This pamphlet was designed to answer some of to or the more common questions that women with epilepsy ask. After reading the pamphlet, be sure er, to discuss any remaining questions with your e physician or nurse practitioner. er a- a- g Pregnancy & Epilepsy Pregnancy booklet inside 1/19/07 3:53 PM Page 2 Birth Control ph m ca Will birth control pills make my ce Q:seizures worse? ca co Birth control pills are a form of hormonal contra- th ceptive, and none of the forms of hormonal con- m traceptives will make your seizures worse. do However, certain medications that control yo epilepsy can reduce the effect of the hormonal contraceptives and therefore increase your chance th of becoming pregnant. The blood levels of one particular antiepilepsy medication, lamotrigine (Lamictal), has been demonstrated to fall when women are also taking Q oral contraceptives. This may cause breakthrough seizures. Be sure the doctor who prescribes your birth W control pills, implants or injections is aware that co you’re also taking an antiepileptic medication. m Your birth control dose may need to be increased. Always use a condom or diaphragm during Th the first month of hormonal contraceptive use. ba or Birth control pills are the oral form of hormonal m contraceptives, and other than abstinence from sexual intercourse, they are the most effective go means of preventing pregnancy. ev Other types of hormonal birth control se include: ua 2 • Contraceptives that are implanted within if the uterus like the IUD Progestasert. sh • Contraceptives that are given by injection yo like medroxyprogesterone (Depo-Provera). Co or None of these hormonal contraceptives will make your seizures worse, but it you are taking a is low or mini dose of any hormonal contraceptive, if and you are also taking antiepileptic medication, di you may become pregnant. or Pregnancy & Epilepsy Pregnancy booklet inside 1/19/07 3:53 PM Page 3 Certain antiepileptic medications such as phenytoin (Dilantin), phenobarbital, carba- mazepine (Tegretol) and topiramate (Topamax) can speed up the metabolism of hormonal contra- ceptives, including birth control pills. The result can make the contraceptive less effective. Oral contraceptives may increase the metabolism and a- thus reduce levels of lamotrigine (Lamictal). This - may cause breakthrough seizures. Be certain the doctor prescribing your contraception knows that you’re taking an antiepileptic medication. Always use a condom or diaphragm during ce the first month of hormonal contraceptive use. sy I’m not certain that I want to become g Q:pregnant right now. What birth con- h trol methods can I use? h Women with epilepsy can use all forms of birth t control but some methods like birth control pills, may need the dose adjusted. d. The choice of a birth control method should be based on your own individual needs. Your doctor or nurse practitioner can help you to choose the method that is best for you. A condom used with contraceptive foam is a good barrier form of contraception if you use it every time you have sex. Other than not having sex, latex condoms are the only way to stop sex- ually transmitted diseases, including AIDS. Even if you use another method of birth control, you 3 should consider using latex condoms to protect yourself from sexually transmitted diseases. Condoms and foam will not affect your seizures or interfere with your antiepileptic medications. The diaphragm used with contraceptive jelly a is another good barrier method of contraception , if you use it every time you have sex. The , diaphragm and jelly will not affect your seizures or interfere with your antiepileptic medicines. Pregnancy & Epilepsy Pregnancy booklet inside 1/19/07 3:53 PM Page 4 The intrauterine device (IUD) is a small piece se of plastic with copper attached (and possibly a Th slow release progesterone), which is placed inside br of the womb by your doctor or nurse practitioner. be The IUD can prevent pregnancy for up to 10 years ca and will not affect your seizures or interfere with m your antiepileptic medications. cu fro Does having epilepsy make it harder of Q:to get pregnant? ep tri Women with epilepsy are less likely to become m pregnant than women without epilepsy. m Doctors have identified several problems associated with epilepsy that could impede your ability to become pregnant. Despite this, most women with epilepsy are able to conceive and give birth to normal, healthy children. As a group, women with epilepsy have fewer chil- Q dren than women without epilepsy, and there are a variety of reasons. No A woman with epilepsy may be less likely to so have children because of problems caused by her du seizures. Or she may have problems with her fo menstrual cycle and reproductive organs. Some m women may not pass eggs from their ovaries reg- ularly, have anovulatory cycles. Or their ovaries ov may develop cysts, a condition called polycystic Ta ovaries. typ 4 All of these problems are classified as repro- ductive/endocrine disorders. Your doctor can test So for them by having you measure your basal body on temperature every morning before you get out of m bed, and by giving you a painless ultrasound test Th to look for ovarian cysts. re Sometimes people with epilepsy (and this so applies to both women and men) are simply not sim as interested in sex as are most people in the gen- ten eral population. This may be due to the fact that cy Pregnancy & Epilepsy Pregnancy booklet inside 1/19/07 3:53 PM Page 5 ce seizures start in the temporal lobe of the brain. The temporal lobe is connected to an area of the de brain called the limbic system where emotional er. behavior is thought to reside. Sexual disinterest rs can also be a side effect of some antiepileptic h medications. If this is a problem, you should dis- cuss it with your doctor. Many women with epilepsy are discouraged from becoming pregnant because of the attitudes r of other people. Fears of having a child with epilepsy, birth defects or other problems can con- tribute to this. It’s important to remember that most women with epilepsy can and do have nor- mal, healthy children. Seizures hy Are seizures caused by my menstrual il- Q:period? e No, menstrual periods do not cause seizures, but o sometimes seizures may worsen or be clustered r during a menstrual period. This is especially true for women who menstruate without ovulation or menstruate irregularly. - Your doctor may prescribe drugs to restore ovulation or regularity to your menstrual cycles.