Part 2 of the discussion we have with the people [women who plan pregnancy] is the impact of pregnancy on the disease. It may have an acute impact. For example, if you have heart failure, the blood volume will increase during pregnancy. This may cause acute heart failure. If you've had a history of venous thrombosis, you may have an acute pulmonary embolism during pregnancy. This is a very acute complication. If you have diabetes, diabetes might be difficult to balance due to pregnancy, etc. Dr. Anton Titov, MD. So these are the acute events that need to be discussed, of course, according to each disease. Pregnancy may aggravate the disease. For example, if you have a substantial chronic renal failure, then it's likely that being pregnant will decrease the survival time of your kidney. Because of that, you may be transplanted earlier. Or if you have chronic eye complication of diabetes, pregnancy may make it more severe in the long run. But usually, it's not in the short run. Dr. Anton Titov, MD. So this was the first part of a pre-pregnancy clinic - information. Then the second part will be - how can we decrease those risks we've been discussing? Once we have disclosed all these risks and possible complications of pregnancy, the question is, how are we going to manage all health risks during pregnancy. The first step is preparation for the pregnancy. For example, if you have diabetes, it is very important that chronic complications be treated beforehand, such as eye complications. It is very important that your blood sugar is perfectly controlled when you are going to become pregnant. If you have HIV, it's very important that you can suppress the presence of HIV in your blood beforehand with drugs that are compatible with pregnancy. If you have an immunological disease, such as lupus erythematosus, it's better that the disease be quiet before you start the pregnancy. All this the physicians who take care of the chronic disease can handle before pregnancy. Then there's the question of genetic counseling. Should we perform prenatal diagnosis or not? Should we perform a pre-implantation diagnosis? These are important issues. Then comes the question of how to manage the pregnancy itself, depending on the type of disease a woman has. Whether it's a rare disease or a more common disease, I think it's important that the obstetrical team would be familiar with this disease, and that the specialist in charge of the disease, in the long run, would be familiarized with a pregnancy of a patient. Just to make things very simple, if you discuss with a patient who has epilepsy and who is pregnant, if you as an obstetrician are not able to understand the symptoms of epilepsy, the patient will not trust you. On the other hand, if a neurologist tells you that "my next appointment will be in two years.” It will be a problem during pregnancy, because pregnancy is something that is rather short. Dr. Marc Dommergues. We need fast answers to our questions on epilepsy during pregnancy.
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