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If a pregnant woman is epileptic, will it harm the fetus?

Q: I am 18 weeks pregnant. I have been taking Tegrital 200 mg twice a day for the past 3 years, but haven't had any seizures since then. My doctor suggested me Microgest in my 1st, 2nd and 3rd month. But I read on your site that Microgest is harmful. I am taking Livogen-z, Tegrital 200 mg, CoBaDex and Macalvit now. I have had a triple marker test and carbamazepine level test done, and both results were normal. The ultrasound was fine too. I am scared for the baby’s mental health. Please tell me if I should do any more tests or any other precautions that should be done?

A:Since you have had no seizures in the past three years, you are in a much better situation to have a baby and after the birth of the baby gradually stop medication under medical advice. Unfortunately there are lots of misconceptions among lay people about epilepsy. A person with well-controlled epilepsy is as normal as a person without epilepsy. A great majority of women with well controlled epilepsy (with medication) have normal pregnancy and normal babies. The frequency of seizures remain the same in 50%, increases in 30% and reduces in 20% of pregnant women. Since you have had no seizures, I think there would be no problem in the remaining period. In the unlikely event of your getting a seizure, the dose of carbamazepine should be increased by about 50%. Abnormality in children born to mothers on anti-epileptic drugs is 5 to 6%. This figure is not that alarming since even in women without epilepsy, the abnormality figure is about 2 to 3%. As an abundant precaution you can get alfa-fetoprotein in blood measured, if this test is available in the place where you reside. At the moment you are on the minimal dose of carbamazepine. This must be continued during pregnancy. The risk of withdrawal of medicine is much more than continuation of the therapy. In addition, 20 mg daily of vitamin K should be taken in the last two weeks of pregnancy and the infant should be given 1 mg of vitamin K on birth to prevent bleeding. Carbamazepine is excreted in the mother's milk to the extent of 25 to 60%; hence baby should be watched for side effects such as drowsiness and allergic skin reactions. In your case an attempt can also be made to gradually stop the medication once the baby is in your lap. Unless you are suffering from any specific deficiency, there is no need to swallow unnecessary, multi-ingredient vitamin/mineral supplements. What you need is a larger-than-normal dose of folic acid due to epilepsy and medication. Livogen-Z contains folic acid 0.75 mg and iron. Cobadex contains B-complex factors, vitamin C and again folic acid 1.5 mg. This quantity of folic acid is not adequate. You should take 5 mg of folic acid till labour. Multi-ingredient products do not contain this quantity of folic acid. Hence you should take Folet or Folvite one tablet a day. Both contain 5 mg of folic acid. If your Hb is low, you can take an iron product such as slow release Fecontin-Z Continus - a tablet daily. Slow release iron is preferable since it is soft on the stomach. It is not necessary to take other supplements. Excessive vitamins are thrown out by the body via kidneys.

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