The following topics should be discussed during preconception counseling:
Weight: The time to reach your appropriate weight is before you decide to have a baby. Obesity may put your pregnancy in a high-risk category. Women who are underweight sometimes ovulate irregularly, or they do not ovulate at all, making it difficult to get pregnant.
Diet: A healthy diet is necessary before, during, and after pregnancy.
Folic acid: This vitamin is essential in preventing fetal malformations, such as neural tube defects and spina bifida, and fetal cardiac problems. This protection applies to the very early stages of pregnancy, so it is vital to start folic acid supplementation at least 1 to 2 months before you conceive.
Home and workspace environment: Remove anything that might be harmful, such as lead paint, asbestos, and toxic chemicals. Cat litter boxes should be handled carefully or eliminated in order to prevent toxoplasmosis, which can be transmitted via cat feces to humans. This infection can damage the human central nervous system, especially that of infants.
Smoking and alcohol: Do not smoke if you are considering becoming pregnant; ask your doctor for help with quitting. This goes for your partner, too. If you drink alcohol, stop as soon as you start trying to conceive.
Risk factors: Discuss the risk factors for major malformations, minor anomalies, and developmental disturbances in the fetus or infant, taking into account family history, type and severity of epilepsy, and/or intrauterine antiepileptic drug (AED) exposure.
Pregnancy complications: Discuss the risk factors for pregnancy complications, such as bleeding, toxemia, and prematurity that may result from AED therapy.
Seizure control and timing of pregnancy: Let your doctor know if you have had frequent major seizures during the year preceding the time you are trying to conceive.
Medications: As noted above, women with epilepsy who are planning to have children should discuss their AEDs thoroughly with their doctors before conceiving, and make any necessary adjustments in AED or dosage.
German measles: Request a blood test for German measles if you do not know whether you have had it in the past or been vaccinated against it. German measles during pregnancy can harm the baby. If necessary, get vaccinated before you get pregnant.
Sexually transmitted diseases: STDs, such as gonorrhea, syphilis, chlamydia, and AIDS, can make it difficult to get pregnant. They can also harm the mother and the baby. STDs should be diagnosed and treated before pregnancy.
Ask your epileptologist the following and any similar questions that you may have:
- Is there a possibility my child will have epilepsy? Can it be inherited?
- Can my medication be reduced or are there safer medications that I can take while pregnant, especially during the first 4 months?
- What are my options for AED withdrawal? (Any drug withdrawal should be completed at least 6 months before planned conception because the risk of seizure recurrence after AED withdrawal is the greatest during the first 6 months.)
- Can my epilepsy be controlled with just one medication?
- How will my AEDs affect the baby and me while I am pregnant?
- Can anything be done to decrease the chance of birth defects?
- Will having a baby affect my need for AEDs or the dose?
- Will morning sickness affect my AEDs?
- Will my seizures be different during pregnancy?
- Do I need any vaccinations?
Your epileptologist, obstetrician, and other health care professionals can help prevent many possible problems for you and your baby, so it is best to see them for preconception counseling before you get pregnant, while you are pregnant, and after the baby is born.
Stacey Chillemi, an epilepsy sufferer for over 27 years, has published numerous articles and books on epilepsy, including Epilepsy: You're Not Alone and My Mommy Has Epilepsy. She is a H.O.P.E. mentor for the Epilepsy Foundation and speaks at numerous schools and organizations in order to educate others about epilepsy. In 2002, Ms. Chillemi was proud to accept the Outstanding Volunteer Award from the Epilepsy Foundation of New Jersey.