Epilepsy & pregnancy

What happens if I have epilepsy and become pregnant?

In perspective, about one woman in 200 has epilepsy. Given that a little less than half of those women are of child-bearing age, in a city of a million people we can expect there to be more than 1,000 women with epilepsy who at some point might plan to get pregnant.

What are the risks to the mother?

Generally speaking the frequency and severity of seizures does not change very much during pregnancy.

What is the risk to the baby?

Firstly, the developing baby is at some risk from direct trauma to the mother's abdomen sustained during a major seizure. There is also risk of temporary lack of oxygen to the fetus brought on by a major maternal seizure. A minor seizure, without falling or any type of convulsive element, is very unlikely to cause harm to the developing baby.

Another area of concern is that anti-epileptic drugs (AEDs) can cause birth defects ranging from mild (e.g., harelip, slight shortening of the fingers) to severe (e.g., major heart defects, neural tube defects such as spina bifida). Those abnormalities, as well as others, occur in about 2% of babies born to healthy, medication-free non-epileptic women. This risk increases to about 4% for epileptic women not taking medications to the region of 5 or 6% in epileptic women on AEDs. Thus the risk is small but tangible.

Is it wise to stop medication to prevent fetal malformations?

Gradual stopping of medication under medical supervision certainly can be considered if the epilepsy is very mild (e.g., seizure-free for two years). If medication is withdrawn it should be done before becoming pregnant because the major organs are already forming in the growing embryo within weeks of conception, even before knowing that one is pregnant. See your doctor before making any plans!

Is there anything else I can do to prevent fetal malformation from medication?

Daily folic acid supplements can reduce the risk of neural tube defect. Folic acid is now recommended to all women throughout their childbearing years, whether or not they are pregnant or plan to get pregnant.

Do some AEDs harm the baby less or more than others?

There are differences but the differences are not very great. Whether any of the newer, recently released AEDs are any safer, is not yet known. The preference is to take an AED that best suits your type of epilepsy.

What tests can I have when pregnant, to know if my baby has been harmed by AEDs?

Maternal blood testing at around 16 weeks can help establish that the developing fetus is healthy and without major defects. This is done by screening mother's blood for three special markers. This test is called "triple marker screening" or TMS for short. The test is not perfect; whereas a negative screen does not guarantee a normal baby, it is correct 99% of the time. A positive screen result for fetal deformity can be followed by amniocentesis (analysis of fluid from the birth sac), and fetal ultrasound examination, for detection of defects.

Can I breastfeed and still be on AEDs?

Contrary to previous beliefs, the answer is now yes. It is now known that only relatively small amounts of the following medications find their way into the breast milk: phenytoin, carbamazepine, and valproic acid, all of which are sanctioned for breastfeeding mothers by the American Academy of Pediatrics.

What is the bottom line?

Except when the epilepsy is very mild, it is better to carry on with AED treatment before and during a planned pregnancy. Whereas the baby can be harmed by medication, this risk has to be set against damage to the developing baby from an uncontrolled seizure or (worse still) a series of seizures not covered by medication. It is really a question of which risk is the smaller one. Continuing with an AED usually wins out.

In conclusion, although there are certain risks to the epileptic mother and her developing baby, those risks are relatively small and are not insurmountable. The fact of the matter is that given good care, a healthy infant is produced in more than 90% of pregnancies occurring in women with epilepsy. The decision whether or not to conceive is clearly a personal one that should be discussed in full with one's partner and personal physician.

Pregnancy: how to prepare

Having a child is one of the most exciting, and stressful, experiences in life. A bit of knowledge and preparation can increase the likelihood of a healthy baby, and can give would-be parents some peace of mind.

What lifestyle changes can I make to help ensure a successful pregnancy?

A healthy lifestyle is always a very good idea, and never is this more true than before and during pregnancy. Things to strive for:

• Eat well. Eat a balanced diet, making sure to include lots of green leafy vegetables and legumes. These will provide folic acid, one of the B-vitamins, which prevents birth defects such as spina bifida (a disorder of the spinal cord).
  
• Take a daily multivitamin with folic acid. Take a daily multivitamin that contains at least 0.4 mg of folic acid to ensure that you have enough nutrients to feed your baby and to reduce the risk of fetal birth defects. Women with epilepsy, diabetes, a family history of neural tube defects (birth defects affecting the spinal cord), or previous pregnancies affected by neural tube defects will need a higher dose of folic acid per day.
  
• Start taking folic acid well before you get pregnant. Talk to your doctor about how much folic acid you will need to take well before you start trying to get pregnant. It is important to take folic acid at least 10 weeks prior to conception, and given that 50% of pregnancies are unexpected, it's best for all women of child-bearing age to take folic acid even if they don't plan to become pregnant.
  
• Exercise regularly. Regular exercise can help prepare your heart for pregnancy and can help you handle the stresses of pregnancy.
  
• Watch your weight. An ideal weight will optimize your chances of successful pregnancy. Ask your doctor what's ideal for you.
  
• Stop smoking. There is no better time to kick the habit, and there is no more important time either. Your health care professional can help.
  
• Decrease your intake of caffeine. Decrease your intake of caffeine (which is found in coffee, tea, cola beverages, and some medications).
  
• Stop drinking alcohol. There is no established safe amount one can drink during, or before, pregnancy.
  
• Stop drug use and stay away from strong chemicals. Discuss with your physician before using any drugs or nonessential medications, and avoid exposure to strong chemicals or toxins.
  
• Learn as much as you can about pregnancy. Read, listen, and talk to your friends and health professionals.
  
• Discuss family issues with your partner regularly. It's best to start discussing family issues even before getting pregnant, and it's especially important to continue these discussions during the pregnancy, as well as after the birth. Having a baby can be a wonderful addition to a family, as long as both partners are ready.
  
• See your doctor regularly. This is another important part of preparing for pregnancy.
  

Diagnosis

The beginning of pregnancy may be detected in a number of different ways, either by a pregnant woman without medical testing, or by using medical tests with or without the assistance of a medical professional.

Most pregnant women experience a number of symptoms, which can signify pregnancy. The symptoms can include nausea and vomiting, excessive tiredness and fatigue, craving for certain foods not normally considered a favorite and frequent urination particularly during night.

A number of early medical signs are associated with pregnancy. These signs typically appear, if at all, within the first few weeks after conception. Although not all of these signs are universally present, nor are all of them diagnostic by themselves, taken together they make a presumptive diagnosis of pregnancy. These signs include the presence of human chorionic gonadotropin (hCG) in the blood and urine, missed menstrual period, implantation bleeding that occurs at implantation of the embryo in the uterus during the third or fourth week after last menstrual period, increased basal body temperature sustained for over two weeks after ovulation, Chadwick's sign (darkening of the cervix, vagina, and vulva), Goodell's sign (softening of the vaginal portion of the cervix), Hegar's sign (softening of the uterus isthmus), and pigmentation of linea alba - Linea nigra, (darkening of the skin in a midline of the abdomen, caused by hyperpigmentation resulting from hormonal changes, usually appearing around the middle of pregnancy).

Pregnancy detection can be accomplished using one or more of various pregnancy tests which detect hormones generated by the newly-formed placenta. Clinical blood and urine tests can detect pregnancy soon after implantation, which is as early as 6-8 days after fertilization. Blood pregnancy tests are more accurate than urine tests. Home pregnancy tests are personal urine tests, which normally cannot detect a pregnancy until at least 12-15 days after fertilization. Both clinical and home tests can only detect the state of pregnancy, and cannot detect the age of the embryo.

In the post-implantation phase, the blastocyst secretes a hormone named human chorionic gonadotropin which in turn, stimulates the corpus luteum in the woman's ovary to continue producing progesterone. This acts to maintain the lining of the uterus so that the embryo will continue to be nourished. The glands in the lining of the uterus will swell in response to the blastocyst, and capillaries will be stimulated to grow in that region. This allows the blastocyst to receive vital nutrients from the woman.

Despite all the signs, some women may not realize they are pregnant until they are quite far along in their pregnancy, in some cases not even until they begin labour. This can be caused by many factors, including irregular periods (quite common in teenagers), certain medications (not related to conceiving children), and obese women who disregard their weight gain. Others may be in denial of their situation.

An early sonograph can determine the age of the pregnancy fairly accurately. In practice, doctors typically express the age of a pregnancy (i.e. an "age" for an embryo) in terms of "menstrual date" based on the first day of a woman's last menstrual period, as the woman reports it. Unless a woman's recent sexual activity has been limited, or she has been charting her cycles, or the conception is as the result of some types of fertility treatment (such as IUI or IVF) the exact date of fertilization is unknown. Absent symptoms such as morning sickness, often the only visible sign of a pregnancy is an interruption of her normal monthly menstruation cycle, (i.e. a "late period"). Hence, the "menstrual date" is simply a common educated estimate for the age of a fetus, which is an average of two weeks later than the first day of the woman's last menstrual period. The term "conception date" may sometimes be used when that date is more certain, though even medical professionals can be imprecise with their use of the two distinct terms. The due date can be calculated by using Naegele's rule. The expected date of delivery may also be calculated from sonogram measurement of the fetus. This method is slightly more accurate than methods based on LMP. The beginning of labour, which is variously called confinement or childbed, begins on the day predicted by LMP 3.6% of the time and on the day predicted by sonography 4.3% of the time.

Diagnostic criteria are: Women who have menstrual cycles and are sexually active, a period delayed by a few days or weeks is suggestive of pregnancy; elevated B-hcG to around 100,000 mIU/mL by 10 weeks of gestation.

Duration & Childbirth

Duration

The expected date of delivery (EDD) is 40 weeks counting from the last menstrual period (LMP) and birth usually occurs between 37 and 42 weeks,^[11] The actual pregnancy duration is typically 38 weeks after conception. Though pregnancy begins at conception, it is more convenient to date from the first day of a woman's last menstrual period, or from the date of conception if known. Starting from one of these dates, the expected date of delivery can be calculated. 40 weeks is nine months and six days, which forms the basis of Naegele's rule for estimating date of delivery. More accurate and sophisticated algorithms take into account other variables, such as whether this is the first or subsequent child (i.e. pregnant woman is a primip or a multip, respectively), ethnicity, parental age, length of menstrual cycle and menstrual regularity.

Pregnancy is considered 'at term' when gestation attains 37 complete weeks but is less than 42 (between 259 and 294 days since LMP). Events before completion of 37 weeks (259 days) are considered pre-term; from week 42 (294 days) events are considered post-term.^[12] When a pregnancy exceeds 42 weeks (294 days), the risk of complications for woman and fetus increases significantly.^[11][13] As such, obstetricians usually prefer to induce labour, in an uncomplicated pregnancy, at some stage between 41 and 42 weeks.^[14][15]

Recent medical literature prefers the terminology pre-term and post-term to premature and post-mature. Pre-term and post-term are unambiguously defined as above, whereas premature and postmature have historical meaning and relate more to the infant's size and state of development rather than to the stage of pregnancy.^[16][17]

Fewer than 5% of births occur on the due date; 50% of births are within a week of the due date, and almost 90% within two weeks.^[18] It is much more useful, therefore, to consider a range of due dates, rather than one specific day, with some online due date calculators providing this information.

Accurate dating of pregnancy is important, because it is used in calculating the results of various prenatal tests (for example, in the triple test). A decision may be made to induce labour if a fetus is perceived to be overdue. Furthermore, if LMP and ultrasound dating predict different respective due dates, with the latter being later, this might signify slowed fetal growth and therefore require closer review.

The Age of Viability has been receding relentlessly as medical revolution continues to unfold. Whereas it used to be 28 weeks, this has been brought back to as early as 23 weeks [22 weeks in a few countries]. Unfortunately, there has been a profound increase in morbidity and mortality associated with the increased survival to the extent it has led some to question the ethics and morality of resuscitating at the edge of viability.

Childbirth

Childbirth is the process whereby an infant is born. It is considered by many to be the beginning of a person's life, and age is defined relative to this event in most cultures.

A woman is considered to be in labour when she begins experiencing regular uterine contractions, accompanied by changes of her cervix — primarily effacement and dilation. While childbirth is widely experienced as painful, some women do report painless labours, while others find that concentrating on the birth helps to quicken labour and lessen the sensations. Most births are successful vaginal births, but sometimes complications arise and a woman may undergo a cesarean section.

During the time immediately after birth, both the mother and the baby are hormonally cued to bond, the mother through the release of oxytocin, a hormone also released during breastfeeding.

Perinatal period

Perinatal period

Perinatal defines the period occurring "around the time of birth", specifically from 22 completed weeks (154 days) of gestation (the time when birth weight is normally 500 g) to seven completed days after birth. ^[10]

Legal regulations in different countries include gestation age beginning from 16 - 22 weeks (5 months) before birth.

This article is about prenatal development in humans. For other species, see prenatal development (non-human).

"Unborn child" redirects here; for other uses, see unborn child (disambiguation).

Prenatal or antenatal development is the process in which an embryo or fetus (or foetus) gestates during pregnancy, from fertilization until birth. Often, the terms fetal development, foetal development, or embryology are used in a similar sense.

After fertilization the embryogenesis starts. In humans, when embryogenesis finishes, by the end of the 10th week of gestational age, the precursors of all the major organs of the body have been created. Therefore, the following period, the fetal period, is described both topically on one hand, i.e. by organ, and strictly chronologically on the other, by a list of major occurrences by weeks of gestational age.

Postnatal period

Postnatal (Latin for 'after birth', from post meaning "after" and natalis meaning "of birth") is the period beginning immediately after the birth of a child and extending for about six weeks. A more correct^{[citation needed]} term would be postpartum period, as it refers to the mother (whereas postnatal refers to the infant). Less frequently used is puerperium.

Biologically, it is the time after birth, a time in which the mother's body, including hormone levels and uterus size, return to prepregnancy conditions. Lochia is post-partum vaginal discharge, containing blood, mucus, and placental tissue.

During the first stages of this period, the newborn also starts his/her adaptation to extrauterine life, the most significant^{[citation needed]} physiological transition until death.

In scientific literature the term is commonly abbreviated to PX. So that 'day P5' should be read as 'the fifth day after birth'.

Progression

Initiation

Pregnancy occurs as the result of the female gamete or oocyte being penetrated by the male gamete spermatozoon in a process referred to, in medicine, as "fertilization", or more commonly known as "conception". After the point of "fertilization" it is referred to as an egg. The fusion of male and female gametes usually occurs through the act of sexual intercourse. However, the advent of artificial insemination and in vitro fertilisation have also made achieving pregnancy possible in cases where sexual intercourse does not result in fertilization (e.g. through choice or male/female infertility).

Terminology

One scientific term for the state of pregnancy is gravid, and a pregnant female is sometimes referred to as a gravida.Neither word is used in common speech. Similarly, the term "parity" (abbreviated as "para") is used for the number of previous successful live births. Medically, a woman who has never been pregnant is referred to as a "nulligravida", and in subsequent pregnancies as "multigravida" or "multiparous".Hence during a second pregnancy a woman would be described as "gravida 2, para 1" and upon delivery as "gravida 2, para 2". An in-progress pregnancy, as well as abortions, miscarriages or stillbirths account for parity values being less than the gravida number, whereas a multiple birth will increase the parity value. Women who have never carried a pregnancy achieving more than 20 weeks of gestation age are referred to as "nulliparous". The medical term for a woman who is pregnant for the first time is primigravida.

The term embryo is used to describe the developing offspring during the first eight weeks following conception, and the term fetus is used from about two months of development until birth.

In many societies' medical or legal definitions, human pregnancy is somewhat arbitrarily divided into three trimester periods, as a means to simplify reference to the different stages of prenatal development. The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus). During the second trimester, the development of the fetus can be more easily monitored and diagnosed. The beginning of the third trimester often approximates the point of viability, or the ability of the fetus to survive, with or without medical help, outside of the uterus.

introducing of PREGNANCY

Pregnancy (latin graviditas) is the carrying of one or more offspring, known as a fetus or embryo, inside the uterus of a female. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets. Human pregnancy is the most studied of all mammalian pregnancies. Obstetrics is the surgical field that studies and cares for high risk pregnancy. Midwifery is the non-surgical field that cares for pregnancy and pregnant women.

Childbirth usually occurs about 38 weeks after conception, i.e., approximately 40 weeks from the last normal menstrual period (LNMP) in humans. The World Health Organization defines normal term for delivery as between 37 weeks and 42 weeks. The calculation of this date involves the assumption of a regular 28-day period.