Janet Ogundepo
Pregnant women who experience poor sleep, stress, low levels of blood sugar and calcium, may have first-time seizures, neurologists have warned.
They noted that epilepsy is the most common cause of seizures and that women with a history of neurological conditions could experience an increase or decrease in seizure frequency during pregnancy.
The neurologists further noted that women who have never had a seizure but have a familial history of epilepsy could also experience seizures during pregnancy.
Additionally, the epilepsy experts asserted that pregnant women without a history of preeclampsia, and who suffer from excessive hunger, low blood sugar, lack of sleep, stress and emotional disturbances could experience first-time seizures.
According to the medical blog Medical News Today, first-time seizures during pregnancy in women without a history of epilepsy are rare, however, seizures can be triggered by complications such as eclampsia, stress, sleep deprivation, and hormonal changes.
John Hopkins Medicine defines seizure as a burst of uncontrolled electrical activity between brain cells that causes temporary stiffness, twitching or limpness and abnormalities in behaviours, sensations or state of awareness.
The American Association of Neurological Surgeons explains that seizure is a symptom of epilepsy.
Meanwhile, the World Health Organisation states that epilepsy is a chronic non-communicable disease of the brain that affects about 50 million people globally.
The WHO also notes that about 70 per cent of people living with epilepsy could live seizure-free with proper diagnosis and treatment, however, the risk of premature death is three times higher than that of the general population.
Aside from epilepsy, women with untreated preeclampsia, which is characterized by high blood pressure during pregnancy, protein in the urine, and swelling in the limbs, could progress to eclampsia, leading to seizures and stroke.
The experts emphasised the need for regular antenatal visits for all pregnant women and the integration of specialist neurological care during the delivery of women with epilepsy.
In an interview with PUNCH Healthwise, a professor of Clinical Neurology and Internal Medicine at the University of Nigeria, Nsukka, Enugu State, Ikenna Onwuekwe, said the most common cause of seizure in pregnancy is epilepsy.
Prof Onwuekwe
He further noted that fever, low and high blood sugar and hypertension, among others, predispose pregnant women with epilepsy to seizures.
The don said, “Fever from any cause, such as malaria, enteric fever, or pneumonia, can predispose to seizures. Low blood calcium levels, which may be related to fluid and hormonal changes at different stages of pregnancy, as well as fluid and electrolyte abnormalities involving sodium, potassium, and magnesium levels, can also contribute.
“Nutritional deficiencies in pregnancy may be associated with seizures. Both low and high blood sugar levels can exacerbate seizures in pregnant women with epilepsy, while hypertensive emergencies in a pregnant woman with epilepsy may cause additional seizures.”
Onwuekwe stated that although women with epilepsy could become pregnant, some experience increased or decreased frequency of seizures during pregnancy.
“During pregnancy, one-third of women with epilepsy have an increase in seizure frequency, another one-third experience a decrease in seizure frequency and the last one-third, don’t experience any difference in their seizure frequency,” he added.
The neurologist also said epileptic seizures in pregnant women may have been diagnosed before pregnancy, or may be brought to light by pregnancy, and mostly occur in women with a predisposition to epilepsy.
The researcher on Stroke/Vascular Neurology and Epilepsy, further noted that pregnant women with epileptic seizures should seek specialist neurological care alongside regular antenatal visits.
He advised, “Many pregnant women with epilepsy give birth to normal babies.
However, proper antenatal care and other health services must be made readily available to women of childbearing age, who can become or are already pregnant.
“It is important that access to specialist neurological care be ensured to guide therapy as considerations may differ. Some medications used to control seizures can be dangerous to the growing baby in women with epilepsy who become pregnant. Common anti-seizure medications such as sodium valproate and phenytoin belong to this category, including many others.
“Such medications can produce congenital malformations in the foetus, especially of the neurologic system leading to anomalies like spina bifida. Using other suitable medications as alternatives and the use of folic acid supplementation in women with epilepsy who become pregnant are known to reduce or eliminate this risk.”
Onwuekwe also said pregnant women with epilepsy should have access to expert care during delivery.
“There is nothing life-threatening about a woman with epilepsy becoming pregnant but such a woman must be cared for by experienced hands in the form of obstetrician, neurologist, midwife and other necessary partners working together as a team during pregnancy and labour.
“Maintaining a good general state of health, early access to maternal and child care services, adequate immunisation history and regular follow-up in the hands of the necessary health professionals usually guarantees the best chances of a safe pregnancy and delivery of a healthy baby for women with epilepsy,” the don added.
Also, a professor of Neurology at the Ahmadu Bello University, Zaria, Kaduna State, Onyeadumarakwe Obiako, said hunger, low blood sugar level, and constant exposure to light from LED screens could predispose pregnant women without a history of epilepsy to seizures.
“Pregnant women who are exposed to hunger can have seizures at any time. Also, hypoglycaemia, which is low blood sugar in pregnant women, can predispose them to seizures.
“Pregnant women who engage in prolonged fasting coupled with vigils or stay awake more than usual, watch television or look at the phone all the time and as a result, constantly get exposed to light can also be predisposed to seizures,” the researcher on Stroke and Epilepsy said.”
The don added that pregnant women, who frequently get angry, engage in fights, and arguments, or experience emotional disturbances are predisposed to seizures.
Obiako, who is currently a WHO/World Bank postgraduate trainer of neurologists at the Edward Francis Small Teaching Institute in Banjul, Republic of Gambia, noted that babies born to women who experienced seizures during pregnancy could be at risk of neurological diseases.
“Each time there is a seizure, blood will be diverted from all parts of the body towards the brain, which means that the child is likely to get less nutrition leading to the child being underweight.
“If the child is not delivered prematurely, aborted, or dies in utero, the child can still suffer brain abnormality. However, it is not correct to say that all pregnant women who have seizures will have babies with brain abnormalities. The chances of these issues are present, but they don’t apply to everyone. The woman can have premature delivery depending on the stage of the pregnancy or the foetus can die in utero.
“Also, during a seizure, a pregnant woman can fall on her stomach, thereby, injuring herself and the baby. So the risk is very high as it can lead to sudden death of the woman or foetal death,” the specialist said.
The don, however, asserted noted that women who have never had seizures but have a familial history of epilepsy could develop seizures during pregnancy.
Obiako added, “If a woman has a familial history of epilepsy in their family, pregnancy can trigger it and make it worse.”
He explained that there are seizures that come with abnormal behaviours but only manifest during epileptic episodes.
“Actually, mental illness can be a seizure itself, but until somebody with a mental illness convulses, that is the time people know that the person has epilepsy. Now, there are seizures with abnormal behavioural tendencies. If those seizures occur in the frontal lobe, most of the time they are non-convulsive.
“But a sudden change in behaviour or action that is unexplained and the patient is unaware of these conditions and after some time, the patient suddenly becomes normal, that kind of situation is likely to be a seizure instead of a psychiatry illness.
“When you see someone just passing by another person and suddenly becomes annoyed and violent and goes to sleep and begins to wonder what happened, that could be a seizure but it can be taken to be a mental illness,” the professor of neurology said.
He noted that while epilepsy could be life-threatening, pregnant women with seizures need more care to prevent further danger to themselves and their babies.
The don affirmed that pregnant women with eclampsia stand the risk of having stroke and could later in life be complicated by post-stroke seizure.
The neurologist urged pregnant women to attend antenatal regularly and ensure that their blood pressure and level of protein in the urine are monitored to detect pre-eclampsia before it progresses to eclampsia.
“So every pregnant woman should be catered for in different ways. Pregnant women should not get excessively annoyed or engage in emotional turmoil. They should sleep well and not be watching films and living on their smartphone for 24 hours. They should not be stressed and must be well cared for. That is the best way a woman will have a safe pregnancy and delivery, and avoid pre-eclampsia and seizures.
“Women who already have seizures before pregnancy should ensure that they visit their doctor and ensure they take the safe therapy because there are drugs that are safe even during pregnancy, after delivery, and during breastfeeding,” Obiako said.
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