A baby born to women with epilepsy: questions and answers

Objective. To study and optimize management tactics for pregnancy and childbirth in women with epilepsy to improve obstetric and perinatal outcomes. Materials and methods. During studies in 2014-2019, the investigators examined 262 pregnant women with cryptogenic epilepsy who delivered infants. Pregnancy and delivery were managed at the Moscow Regional Research Institute of Obstetrics and Gynecology. Special attention was paid to the nature of the course of the underlying disease, to antiepileptic drug therapy, and to the presence of convulsive seizures. The examination included a complete standard clinical and diagnostic testing, a study of fetoplacental complex hormones, antiepileptic drug (AED) concentrations, and immunological and morphological studies. Results. Despite a neurological pathology that requires continuous AED use and the pharmacoresistant form of the disease in some pregnant women, the complicated course of pregnancy and childbirth was not observed in most cases. Labor pain was relieved in women with epilepsy according to obstetric indications; however, a combined method for labor pain relief was used in persistent convulsive seizures in the third trimester, which allowed the maximum sedative and analgesic effects to be achieved. 89% of babies were born in a satisfactory condition owing to the adequate monitoring of a pregnant woman with epilepsy and timely correction of obstetric complications. The birth of babies with congenital malformations (CMs) in two cases was due to the fact that there was no their prevention at the stage of pregnancy planning. Conclusion. The successful course of pregnancy and childbirth in women with epilepsy requires that the pregnant woman should be monitored jointly by an obstetrician/gynecologist and an epileptologist/neurologist, who is competent in the course of epilepsy in females and pregnant women. The most common failure of drug-induced remission was observed in the second trimester of pregnancy, which needed to increase the dose of AEDs or switching to combination therapy. Obstetric complications were treated according to standard clinical protocols.

epilepsy, pregnancy, childbirth, newborns, labor pain relief