Women, Pregnancy, and Epilepsy

If you have epilepsy and are thinking about getting pregnant, you probably have some important questions. Is it safe for me to get pregnant? Will having epilepsy make it harder for me to conceive? If I do get pregnant, how will I manage my seizures while I'm expecting? Could my antiseizure drugs harm my baby?

Fortunately, most women with epilepsy give birth to normal, healthy babies, if you take precautions, your chance of having a healthy child is greater than 90%. There are increased risks. But working closely with your doctor can help minimize those risks.

Before you try to conceive, you should talk to your neurologist and your obstetrician. Most doctors recommend that women with epilepsy be cared for by a high-risk obstetrician during their pregnancy. Both will want to monitor you closely throughout.

Getting Pregnant With Epilepsy

It's possible that having epilepsy may make it more difficult for you to get pregnant. Women with epilepsy have fewer children than women in general. Their fertility rate is between 25% and 33% lower than average. Why is this? Here are some possible reasons:

  • Women with epilepsy have higher rates of some conditions that can cause infertility. One of these is polycystic ovarian syndrome (PCOS).
  • Women with epilepsy are more likely to have irregular menstrual cycles, which can make it more difficult to get pregnant.
  • Women with epilepsy are also more likely to have menstrual cycles that do not produce an egg. These are called anovulatory cycles.
  • Some antiseizure drugs may affect the hormone levels in your ovaries, which can affect reproductive functioning.
  • Women with epilepsy are more likely to have abnormalities in hormones involved in pregnancy.

If your seizures are not under control, that may affect your fertility, as well. Experts say that if a woman is having seizures around the time her body is preparing to ovulate, they may disrupt the signals that make that process occur.

Once you become pregnant, it will be even more important to control your seizures. Having seizures during pregnancy can affect of the health of your baby. You might fall, or the baby may be deprived of oxygen during the seizure, which can injure the baby and increase your risk of miscarriage or stillbirth.

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Unfortunately, some of the most common drugs for controlling seizures have been found to increase the risk of birth defects. In the general population there is a 2%-3% chance that a child will have a birth defect. In women with epilepsy, this risk goes up to 4%-8%.

To help decrease the chance of birth defects, especially neural tube defects that can affect the brain and spinal cord, women with epilepsy should take at least 0.4 milligrams per day of folic acid supplements, before they try to conceive.

Epilepsy Drugs Safe for Pregnancy

You can have a normal pregnancy. Talk to your doctor before you try to get pregnant and he will help choose the safest medication at lowest dose for seizure control, and for the health of your baby. You may need to change your medication or adjust your dose. Never stop taking your medication without first talking to a doctor. During your pregnancy you will need to see a specialist to monitor your pregnancy and the health of your baby. You may get extra fetal monitoring

There are no antiseizure drugs that are completely without risk of causing birth defects. But some antiseizure medications appear to be more dangerous for a developing baby than others, and your doctor may be able to avoid prescribing them. Here's what doctors know so far:

  • Valproate, valpoic acid (Depakene, Depakote) seem to carry the highest risk of damage to the baby, particularly neural tube defects, such as spina bifida.

What makes things a bit more confusing is that information about the safety of antiseizure drugs during pregnancy is changing all the time. As a result, managing epilepsy during pregnancy can be complicated. If you who want to become pregnant make sure you see a doctor who keeps up to date on all the newest research. You can also check with the Epilepsy Foundation if you have questions.

Prepare in Advance for Pregnancy With Epilepsy

Depending on what your doctor says about your epilepsy, you may want to change medications before you get pregnant, or it might be fine to stay with the one you are taking now. If you are taking more than one antiseizure drug, your doctor may recommend that you taper down to just one. That's because combinations of drugs to treat epilepsy have a higher risk of causing birth defects than just one drug alone.

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If you are making any changes in your antiseizure medications at all, you should do that at least a year before getting pregnant. Switching medications has risks, too. You may not respond well to the new drug and have breakthrough seizures, which could be harmful to a pregnancy. When changing medications, doctors will usually add the new drug before stopping the old one. If you become pregnant during this time, the baby could be exposed to both drugs instead of just one.

Whether you change seizure drugs or not, be sure to add folic acid to your daily schedule. Starting before you get pregnant, take prenatal vitamins with 0.4 milligrams of folic acid every day, and keep taking them throughout the pregnancy. Folic acid has been shown to reduce the risk of some birth defects by 60% to 70%. Because there are some extra risks associated with pregnancy when you have epilepsy, it's important to do everything you can to minimize those risks.

Epilepsy and Labor

Many women with epilepsy worry that they will have a seizure during labor. This is an understandable fear. As your pregnancy progresses, your metabolism changes. By the time you are nine months pregnant, the blood volume in your body is 50% greater than it was before you got pregnant. This means that the antiseizure medications in your body will be more diluted. That's why your doctor will be monitoring the levels of medication in your blood throughout your pregnancy, and might increase the dosage if it's getting too low.

So when labor starts, you may already be a little more vulnerable to a seizure. Then, you may miss a dose, because things don't always go exactly according to plan when a woman goes into labor. You will also be in pain and breathing hard, which can increase the chance of a seizure. This doesn't mean that seizures are common during labor and delivery, but they are a possibility.

What happens if you do have a seizure during labor? Your doctor may give you IV medication to stop the seizure. If that doesn't work, you may have to have a caesarean section. Although most women with epilepsy have normal vaginal deliveries, they do have a higher rate of C-sections than other women. Sometimes, anticonvulsant drugs can also reduce the ability of the muscles of your uterus to contract. If this happens, your labor might not progress as well and a C-section may be your best option.

All of these concerns can seem overwhelming, but there's no need to become overly anxious. It's important to be aware of the risks. But it's also important to keep in mind that the vast majority of women with epilepsy get through pregnancy just fine. Your chances of having a healthy child are excellent, especially if you talk with your doctor early and often, follow the advice you are given, and take good care of yourself.

WebMD Medical Reference Reviewed by Richard Senelick, MD on June 17, 2016

Sources

SOURCES:

Epilepsy Foundation, Women and Epilepsy Initiative: "Pregnancy Issues."

Jacqueline French, MD, professor of neurology, NYU Langone Medical Center; co-director, Epilepsy Research and Epilepsy Clinical Trials, NYU Comprehensive Epilepsy Center. 

Goetz, C. Textbook of Clinical Neurology, 2nd ed., Saunders, 2003. 

Morrell M. American Family Physician, Oct. 15, 2002. 

Mark Yerby, MD, MPH, associate clinical professor of Neurology, Public Health & Preventive Medicine, Oregon Health Sciences University, Portland, Oregon; founder, North Pacific Epilepsy Research, Portland.

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