Pregnancy and epilepsy

Women with epilepsy can have healthy children, and over 90% who decide to have children deliver healthy babies.¹ But the risk of serious birth defects in the child is around 4% to 6%-about double the risk for the general population.²

If you have epilepsy and become pregnant, stopping medicine treatment is not always the best solution. Having seizures during pregnancy can also harm the baby, and pregnancy causes changes in your body that may increase the frequency of seizures.

The following information is based on guidelines from the American Academy of Neurology.¹

Before you become pregnant

Before you become pregnant, it is best to talk with your doctor about your epilepsy treatment. Seizures or seizure medicine may cause damage to the baby very early in your pregnancy, before you even know that you are pregnant. Your doctor will help you consider whether potential seizures or continued use of antiepileptic medicine poses greater risk to your baby.

If you are not yet pregnant but are planning to become pregnant, stopping medicine might be an option if you have been seizure-free for several years. Your doctor may suggest a trial run without the medicine before you become pregnant. Experts advise that this trial run take place at least 6 months before the pregnancy so that you and your doctor can see the results of stopping your treatment. If you begin having seizures, you may need to go back on medicine.

While you are pregnant

If you need to stay on medicine during your pregnancy, you may be able to make some changes in your treatment that reduce the risk of birth defects. These changes may include:

• Switching to a medicine that is safer for the baby.
• Taking a single medicine.
• Decreasing the medicine dosage. (Some women may have to increase their medicine dosage during pregnancy, because they have more seizures than they normally do.)
• Taking folic acid, vitamin K, or other supplements before you conceive and during certain times of your pregnancy. (Folic acid reduces the risk of some birth defects. Some antiepileptic medicines can cause a temporary blood disorder in newborns that makes it difficult for their blood to clot normally. Vitamin K can help prevent this problem.)

Do not change, reduce, or stop taking your medicine while you are pregnant without first consulting your doctor. You may put yourself and your baby at greater risk if you do.

Other concerns

• During your pregnancy, you may need more frequent checkups to monitor the baby's condition and blood tests to monitor your drug levels.
• After your baby is born, he or she may need to take extra vitamin K for a short period of time. (Some antiepileptic medicines can cause a temporary blood disorder in newborns that makes it difficult for their blood to clot normally. Vitamin K can help reverse this problem.)
• Breast-feeding while you are taking antiepileptic medicine is usually safe, but talk to your doctor about any concerns you have. If you are taking a barbiturate (such as phenobarbital) to control your seizures, breast-feeding may make the baby drowsy or irritable, because the drug may get into your breast milk.

If you have epilepsy and find out that you are pregnant, consult your doctor immediately. Do not stop taking your medicine without first talking to your doctor.

Citations

1. American Academy of Neurology (1998). Practice parameter: Management issues for women with epilepsy (summary statement). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 51(4): 944–948.

2. Schachter SC (2003). Epilepsy: Etiology and manifestations. In RW Evans, ed., Saunders Manual of Neurologic Practice, part VII, pp. 244–265. Philadelphia: Curtis Center.