Pregnancy Advice

[Claire7]

Am hoping for some advice on pregnancy and what vitamins etc I should be taking.
I was 19 weeks pregnant when I had my first seizure type experience. Neuro put it down to a fainting fit. I had woken up lying on my bump, felt that this was odd so got up went downstairs when it then happened. Apparently my blood pressure was low and for about 24 hours after they said that the blood flow was restricted in the vagus nerve in my neck. I didn't realise the significance of this until reading info on this. Still don't understand 100% though!!!

I had a seizure 8 months ago which was 4 years later. I decided to go on medication for piece of mind and currently take 200mg of lamictal. I would love to have another baby and it was always our plan for this year.
Just wanted some advice on what vitamins I should be taking or anything I can do to raise my seizure threshold naturally whilst pregnant. Obviously not lying on a baby bump would be a good place to start!!! I am taking 5mg folic acid and 500mg of magnesium. I heard that this was also good for placenta health and considering I had a placenta abruption last time hopefully it will help.

Any advice out there would be a great help!

 

[Wobblez]

Hi Claire7,

Welcome to the forum! I don't really know enough about Lamictal and pregnancy to give you any definitive info but as I take 400mg Lamictal daily, I have done a little research on it.

Apparently it is preferable to only be on one type of medication at a time (monotherapy) during pregnancy, as opposed to having a lower dose of one medication, but compensating by adding a second.

You can also try and find an optimal seizure threshold, by lowering your medication and finding other ways to compensate, e.g. nutrition, relaxation, bed rest etc, obviously with your doctor's assistance!

Studies show an association between women taking Lamictal and up to a 3 fold chance of foetal abnormalities and language abilities in the child. From memory this equates to roughly a 6% chance of abnormalities. I don't know enough about it but I personally will look into having an amniocentesis because of this increased risk. The first trimester is the time of most concern, because that is the "critical period" of development, e.g. brain, organs and limbs etc. The foetus is then more resilient in the 2nd and 3rd trimesters.

I often wonder if I could get away with total bed rest and dealing with partial and complex seizures, if it meant I could get through the first trimester medication free. But you also have to toss up the dangers of seizures to you and the baby, vs the potential danger of medication side effects to the baby.


In the grand scheme of things though, if you eat well, exercise and try and keep your meds as low as possible, you should be fine. Look at these poor babies that are born with heroine addiction, and still come out of it okay. Or smokers, drinkers, recreational drug users etc.

If you search "Lamictal and pregnancy" on these forums, you'll find heaps of recent posts about it. Oh andsuss out Elevite, the pregnancy vitamin. That is supposedly really good. And please share what you learn, I'm very interested =)

 

[Nakamova]

Lamictal gets cleared out of your system faster when estrogen levels rise -- as happens during pregnancy. Your neurologist and OB/GYN should both be aware of this, and should be checking your Lamictal levels from time to time over the course of the pregnancy. If your Lamictal levels become too low, the dosage may need to be increased to compensate. And then once you give birth, the dose would need to be reduced back down to avoid toxicity.

 

[Claire7]

Thanks for the responses. I did ask the GP a while back if they test the blood levels during pregnancy to make sure it is at the correct level and she said no. She looked in her little medicine guide which told her that lamotrigine levels do not change during pregnancy. Since being on medication I have never had a blood test to check levels. How do I know if my dose is too high or too low!? The neurologist just told me that a lot of people are seizure free on 150mg but the majority are seizure free at 200mg.
The hospitals here do not routinely do an amniocentesis unless the blood tests they do at about 12 weeks show that there could possibly be a problem.

 

[Nakamova]

I did ask the GP a while back if they test the blood levels during pregnancy to make sure it is at the correct level and she said no.

Nope, she's wrong:

About 20% to 35% of women have seizures more often during pregnancy because of changes in hormones or changes in how their seizure medicine is handled by the body. This appears to be particularly true for lamotrigine. Lamotrigine levels have been found to drop significantly and quickly in pregnant women. Your doctor will not only want to check levels of medicine in the blood regularly during pregnancy, but may want to increase your dose as soon as the pregnancy is discovered. Similarly, these changes revert back to normal just after delivery and your doctor will then again discuss with you how to begin lowering lamictal once the baby is born.

(from http://epilepsy.med.nyu.edu/treatment/medications/lamotrigine)

 

[Claire7]

Thanks for that info! It is so hard to know what to do! I'm scared that they won't bother checking the levels and then I'll get stressed and that must be my main trigger. Obviously there is a good chance that I will be fine during pregnancy as I have only had 2 seizures in over 4 years.
The neurologist seemed to think that if there was an optimum time to have a second seizure it would have been 4 months after the first when I had my placenta abruption, emergency c-section, general anaesthetic, lost 3 litres of blood, had blood transfusion and had pre-eclampsia! I was absolutely fine! The difference being is that I was so happy. I had this gorgeous baby boy, it is such a euphoric feeling. When I had my seizure 4 months previously I was so unhappy and depressed and felt guilty for being pregnant as it was causing problems in my family. I was also 19 weeks pregnant by then where hormones have kind of settled down.

 

[Nakamova]

I agree, given that you've had only a few seizures, that bodes well that everything will go well for you during he pregnancy. But it doesn't hurt to give your doctors a nudge about testing your levels -- remember, they work for you, not the other way around.

 

[Claire7]

Do you know what vitamins are advisable to take? Asked the pharmacist and they weren't much help! I am taking 5mg of folic acid which I have been taking since September as it was prescribed by the neurologist. I am also taking 500mg of magnesium with added B6. I know I should take some sort of omega supplement as I don't eat fish but I tried some years ago that smelt of fish and tasted like it so totally put me off!
I looked in the pharmacy today and they did have a pre conception vitamin that had omega 6 in it I think plus 4mg of folic acid. I presume I couldn't take that as then I would possibly be overdosing on folic acid at 9mg!!!

 

[Nakamova]

Sounds like you have a good start. Folic acid is definitely key. The recommended dose is 0.4 to 0.8 mg. The other B-vitamins, magnesium, and calcium are important too as well as iron. As for the Omega3s, you can also get them from flax oil capsules, which may be easier to take. Omega6s are the ones to avoid -- most people get more than plenty of them in the modern Western diet, and not nearly enough Omega3s.

You should be able find a single pre-natal vitamin that has all or nearly all of the above, including Omega3 (you may see it as "DHA"in the ingredient list).

 

[Claire7]

Thanks so much for the advice Nakamova! So if I take a pre-natal vitamin as well as the 0.5 folic acid the neuro prescribed that wont be too much?

 

[Nakamova]

If you find a prenatal vitamin that has 4 or 5mg of folic acid already in it, then you shouldn't take a separate folic acid supplement. That might be the way to go, since almost all prenatal vitamins have folic acid.