Epilepsy and pregnancy: what you need to know

Epilepsy and Pregnancy: What You Need to Know

Mayo Clinic staff

epilepsy during pregnancy is of particular concern. While most people with epilepsy will have healthy babies, you may need special care during pregnancy. Here’s what you need to know.

Does epilepsy make pregnancy more difficult?

Seizures alone will not affect your ability to conceive. However, some medications used to treat seizures can make pregnancy more difficult. Certain anti-seizure medications can reduce the effectiveness of hormonal birth control methods. If you are considering having a baby, ask your healthcare provider if your medication needs to be changed.

How does epilepsy affect pregnancy?

The following problems can occur when a seizure occurs during pregnancy:

• Slow fetal heart rate
• Decreased fetal oxygen supply
Preterm birth
Low birth weight

Preterm birth trauma to the mother, such as a fall, may result in fetal injury, premature separation of the placenta from the uterus (placental abruption) or even fetal loss

How high your risk for these problems depends on the type of seizure you have. Discuss your risk level with your healthcare provider.

Does epilepsy change during pregnancy?

Everyone’s body responds to pregnancy differently. For most pregnant women with epilepsy, the number of seizures remains the same, or the frequency of seizures decreases. For others, especially those who don’t get enough sleep or don’t take their medicines as prescribed, pregnancy can increase the number of seizures.

How about the medicine?

You were taking it during pregnancy medicines can affect your baby. Birth defects — including cleft palate, neural tube defects, bone problems, heart and urinary tract problems — are some of the potential side effects associated with antiepileptic drugs. If you take more than one antiseizure drug, the risk seems to increase with increasing dose.

If you did not have a seizure during the first nine months of pregnancy, you are less likely to have a seizure during pregnancy. If you’ve been seizure-free for 2 to 4 years, you may be able to tape off your medication before getting pregnant to see if you’re still seizure-free. Talk to your healthcare provider before you stop taking any medicines.

For most people, it is best to continue epilepsy treatment during pregnancy. To minimize your risk, your healthcare provider will prescribe the safest medications and doses that are effective for your type of seizure. Seizure drug levels can be monitored throughout pregnancy.

How should I prepare for pregnancy?

Before you try to conceive, make an appointment with the healthcare provider who will handle your pregnancy. You may want to speak with a provider who specializes in high-risk pregnancies. Also meet with other members of your healthcare team, such as your primary care provider and your neurologist. They will assess how well you control your epilepsy. Your provider may also consider treatment changes you may need to make before you become pregnant.

If you had frequent seizures before pregnancy, you may be advised to wait until your seizures are better controlled.

Take anti-seizure medication exactly as prescribed. Do not adjust your dose or stop taking your medication without talking to your healthcare provider. Uncontrolled seizures may put your baby at greater risk than medication.

Healthy lifestyle choices are also important:

• healthy diet. Take prenatal vitamins. Get enough sleep.
  Avoid caffeine, cigarettes, alcohol and illegal drugs .

  Why is folic acid important?

  Folic acid helps prevent serious problems of the brain and spinal cord called neural tube defects. The American College of Obstetricians and Gynecologists recommends that women with epilepsy take a daily multivitamin containing 0.4 mg of folic acid. Your healthcare provider may recommend a higher dose based on your situation. It is best to start taking folic acid supplements in the first trimester of pregnancy.

  What can I expect during my antenatal visit?

  During pregnancy, you will see your healthcare provider frequently. Your weight and blood pressure will be checked at each visit. You may need frequent blood tests to monitor your drug levels.

  If you are taking anti-seizure medication, your healthcare provider may recommend that your baby take vitamin birth K. This can help prevent rare bleeding problems in babies born to some people with epilepsy. In some cases, vitamin K may be recommended during the last month of pregnancy.

  What if I have a seizure while I am pregnant?

  Seizures can be dangerous, but many people who have seizures during pregnancy give birth to healthy babies. Report seizures to your healthcare provider right away. Your medication may need to be changed. If you have a seizure during the last few months of pregnancy, your healthcare provider may monitor your baby in a hospital or clinic.

  How can I make sure my baby is okay?

  Your healthcare provider will monitor your baby’s health throughout your pregnancy. You may need frequent ultrasounds to track your baby’s growth and health. Your healthcare provider may also recommend other prenatal tests.

  How about labor and delivery?

  Most people with epilepsy give birth without problems. Seizures do not often occur during childbirth. If you have a seizure during labor, it may be stopped by intravenous medication. If the seizures persist for a long time, your healthcare provider may deliver by cesarean section.

  If your anti-seizure medication dose is changed due to pregnancy, talk to your healthcare provider about returning to pregnancy shortly after your baby is born previous level. This will help control your seizures and keep your medication at safe levels.

  Can I breastfeed my baby?

  Most people with epilepsy are encouraged to breastfeed, even those taking antiepileptic drugs. Discuss breastfeeding with your healthcare provider ahead of time. You may need to take medicine after feeding. Sometimes dressing changes are required.

  • August. December 12, 2022

    Risks during pregnancy. Epilepsy Foundation. http://www.epilepsy.com/learn/impact/reproductive-risks/risks-during-pregnancy. Accessed July 13, 2022. American College of Obstetricians and Gynecologists. Seizures. Clinical Updates in Women’s Health. 2021; https://www.acog.org/clinical/journals-and-publications/clinical-updates. Accessed July 13, 2022.

    Landon MB et al., eds. Neurological disorders during pregnancy. In: Gabbe’s Obstetrics: Normal and Problem Pregnancy. 8th edition. Elsevier; 2021. https://www.clinicalkey.com. Accessed July 14, 2022.

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