By stacey chillemi, freelance writer
During your pregnancy, you will see your neurologist and OB-GYN often. The most common prenatal tests you might undergo over the next nine months of pregnancy.
Some tests, such as urine or blood tests, might be repeated during your pregnancy, as will routine blood pressure screening. Others, such as CVS and amniocentesis, may not be offered unless your age or other factors indicate that you or your babies are at higher risk for certain conditions or diseases.
Your neurologist will do blood tests to be sure that you are getting enough medicine for your seizures. It is very common for changes to be made in the dose of your medicine during your pregnancy. Your neurologist may also want you to have several ultrasound exams (called sonograms) during your pregnancy.
Pregnancy ultrasound is a method of imaging the fetus and the female pelvic organs during pregnancy. The ultrasound machine sends out high-frequency sound waves that bounce off body structures to create a picture. There is no definitive rule as to the number of scans a woman should have during her pregnancy. Some OB-GYN will order an ultrasound when an abnormality is suspected on clinical grounds, while others support screening ultrasounds. I had several done during my pregnancy. You should consult your OB-GYN to determine how many you should have and when you should have them.
Scans may be performed in the first trimester to:
- Confirm a normal intra-uterine pregnancy
- Assess fetal age
- Assess fetal heart activity
- Determine the presence of multiple pregnancies
- Identify abnormalities of the placenta, uterus, and other pelvic structures
- Scans may also be obtained in the second and third trimesters to:
- Assess fetal age, growth, position, and sometimes gender
- Identify congenital malformations
- Exclude multiple pregnancies
- Evaluate the placenta
- Evaluate amniotic fluid
- Evaluate remaining structures of the pelvis
Some centers are now performing a scan at around 13-14 weeks of pregnancy to screen for findings that may represent a risk for Down syndrome (a type of chromosomal defect, which causes mental retardation) or other developmental abnormalities, in the fetus. The total number of scans will vary depending on whether a previous scan or blood tests have detected abnormalities that require follow-up evaluation.
You may even have an amniocentesis. (Amniocentesis is a diagnostic procedure performed by inserting a hollow needle through the abdominal wall into the uterus and withdrawing a small amount of fluid from the sac surrounding the fetus).
During pregnancy, one quarter to one third of women with epilepsy have more seizures even though they are using medicine to control their seizures. Decreased protein necessary of anti epileptic drugs, increased drug clearance, and increased maternal plasma volume during pregnancy may lower serum concentrations of antiepileptic drugs, requiring more frequent laboratory assessments, and dosage adjustments. Plasma levels of unbound antiepileptic drugs should be monitored closely throughout pregnancy and for at least 8 weeks following delivery, as it is common for levels to rise in the postpartum period.
It is generally thought that women with epilepsy have at least a 90 percent chance of having a normal, healthy baby. All women have roughly a 2 percent to 3 percent chance of giving birth to a baby with some type of malformation. It is unknown what the exact causes for an increased rate of abnormality; a number of factors are thought to increase congenital malformations in the children of women who have epilepsy.
These factors include genetic predisposition, seizures that occur during pregnancy, and the effects of antiepileptic drugs. It is estimated that mothers with epilepsy have approximately twice the risk of having a baby born with a malformation than women in the general population, an approximately 4 percent to 6 percent risk.
The most common malformations include neural tube defects such as spinal bifida (characterized by the protrusion of spinal chord membranes through abnormal gaps between vertebrae), cleft palate, cleft lip, and congenital defects that affect the heart. Some minor abnormalities, including developmental delay, speech abnormalities, widened eye set, flattened nasal bridge, small fingernails, and other structural features have also been described in association with antiepileptic drug treatment.
These minor abnormalities have no long-term medical ramifications. Fertility rates (giving birth to live offspring) are lower in persons with epilepsy. This may be linked partly to hormonal changes and menstrual irregularities associated with the disease.
