Epilepsy & Pregnancy

The combination of epilepsy and pregnancy might seem risky, but the odds are in your favor. Find out how to promote a healthy pregnancy.  By Mayo Clinic Staff

Years ago, women who had epilepsy were often discouraged from getting pregnant. Today, that’s no longer the case. Thanks to early and regular prenatal care, more than 90 percent of pregnant women who have epilepsy deliver healthy babies, according to the Epilepsy Foundation. If you have epilepsy and are considering pregnancy, here’s what you need to know.

Some women who have epilepsy have menstrual irregularities and other gynecological problems, such as polycystic ovarian syndrome, that might make it harder to conceive. Medication might be an issue as well. Some drugs used to treat seizures might contribute to infertility. Keep in mind, however, that certain seizure medications can also reduce the effectiveness of hormonal birth control methods.
Women who have epilepsy face a higher risk of pregnancy-related complications including:

  • Severe morning sickness
  • Anemia
  • Vaginal bleeding during and after pregnancy
  • Premature separation of the placenta from the uterus (placental abruption)
  • High blood pressure and excess protein in the urine after 20 weeks of pregnancy (preclampia)
  • Premature birth
  • A low birth weight baby
  • Failure to progress during labor and delivery
  • Babies with congenital anomalies
Every woman reacts to pregnancy differently. For most pregnant women who have epilepsy, seizures remain the same. For a few seizures, become less frequent. For others particularly women who have poorly controlled epilepsy pregnancy increases the number of seizures.
Any medication you take during pregnancy can affect your baby. Birth defects including cleft palate, neural tube defects, skeletal abnormalities, and congenital heart and urinary tract defects are the primary concern with seizure medications. In addition taking certain seizure medications such as those that contain valproate, or more than one seizure medication during pregnancy can increase the risk that your baby will have impaired cognitive development. Valproate products include valproate sodium (Depacon), divalproex sodium (Depakote, Depakote ER) and valproic acid (Depakene Stavzor). Other problems caused by seizure medications, such as wide-set eyes or a short upper lip though it isn’t clear whether this is related to the drugs or the disease.

For babies whose mothers take seizure medication, the risk of birth defects is 4 to 8 percent compared with 2-3 percent for all babies according to the Epilepsy Foundation. The risk seems to be highest when more than one seizure medication is taken, particularly at high doses . Without medication, however, uncontrolled seizures might deprive the baby of oxygen. Seizures can also increase the risk of miscarriage or stillbirth.

A few women can safely taper off their medication before pregnancy. For most women, however, it’s best to continue treatment during pregnancy. To minimize the risks for you and your baby, your health care provider will prescribe the safest medication and dosage that’s effective for your type of seizures. Your health care provider might recommend avoiding use of valproate or use of more than one seizure medication during the first trimester of pregnancy or throughout pregnancy. Keep in mind that no single medication is best for everyone.

During pregnancy and shortly after delivery, the concentration of seizure medication in your blood might decrease putting you at greater risk of seizures. As a result, your health care provider will monitor the concentration of seizure medication in your blood and adjust the dosage as needed. Remember, uncontrolled seizures pose a greater risk to your baby than does any medication.

Beyond the effects of medications, babies born to mothers who have epilepsy also have a slightly higher risk of developing seizures as they get older.
Before you try to conceive, schedule an appointment with the health care provider who’ll be handling your pregnancy. Also meet with other members of your health care team such as your family doctor or neurologist. They’ll evaluate how well you’re managing your epilepsy and consider any treatment changes you might need to make before pregnancy begins. Take your seizure medication exactly as prescribed. Don’t adjust the dose or stop taking the medication on your own.

It’s also important to make healthy lifestyle choices. For example:

  • Eat a healthy diet
  • Take pre-natal vitamins
  • Include physical activity in your daily routine
  • Keep stress under control
  • Get enough sleep
  • Avoid smoking, alcohol and illicit drugs
  • Limit the amount of caffeine in your diet
  • Avoid exposure to chemicals such as those found in pesticides, paints, and oven cleaners
Folic acid helps prevent neural tube defects, serious abnormalities of the brain and spinal cord. Because some seizure drugs affects the way the body uses folic acid, your health care provider might recommend a high-dose folic acid supplement ideally starting three months before conception.
During pregnancy, you’ll see your health care provider often. Your weight and blood pressure will be checked at every visit, and you might need frequent blood tests to monitor your medication levels. If you’re taking seizure medications, your health care provider might recommend oral vitamin K supplements during the last month of pregnancy to help prevent bleeding problems in the baby after birth.
Seizures can be dangerous, but many mothers who have seizures during pregnancy deliver healthy babies. Report the seizures promptly to your health care provider. He or she might adjust your medication to help prevent other seizures. if you have a seizure in the last few months of your pregnancy, your health care provider might monitor your baby at the hospital or clinic.
Your health care provider will closely monitor your baby’s health throughout the pregnancy. Frequent ultrasounds might be used to track your baby’s growth and development. Depending on the circumstances, your health care provider might recommend other prenatal tests. What you find out might help you understand the odds and make important decisions about your pregnancy.
Most pregnant women who have epilepsy deliver their babies without complications. Women who have epilepsy might use the same methods of pain relief during labor and delivery as other pregnant women. Seizures don’t commonly occur during labor. If you do have a seizure during labor, it might be stopped with intravenous medication. If the seizure is prolonged, your health care provider might deliver the baby by C-section. If you have frequent seizures during your third trimester, your health care provider might recommend an elective C-section to avoid the risk of seizure during labor.
Breast-feeding is encouraged for most women who have epilepsy, even those who take seizure medication. Discuss any adjustments you’ll need to make with your health care provider ahead of time. Sometimes a change in medication is recommended.