Epilepsy and Women

Medically Reviewed by Gabriela Pichardo, MD on June 27, 2020

 About 500,000 women of child-bearing age in the U.S. have a seizure disorder. Not only do they have to cope with seizures, they must also deal with the impact the disorder can have on their reproductive health. Epilepsy and seizure medications may affect contraception, pregnancy, hormone levels, and the female reproductive cycle.

Epilepsy and Birth Control

Women with epilepsy who are sexually active should consult with their doctors regarding contraception and pregnancy. Many seizure drugs can prevent birth control pills from working effectively, which can lead to an unplanned pregnancy. Other methods of birth control may be more effective in certain cases. Don't wait until it's too late to discuss birth control with your doctor.

In addition, all women of child-bearing age should take a multivitamin containing folic acid daily, to help prevent certain birth defects should pregnancy occur. Women who are taking seizure medications should be especially careful about taking a multivitamin and extra folic acid (check with your doctor about the exact dose), because some epilepsy medications deplete the body of important vitamins, particularly folic acid.

Epilepsy and Pregnancy

Women with seizures can have healthy children, provided they receive good prenatal care. It is very important that women with epilepsy discuss pregnancy with their doctors beforegetting pregnant.

Many patients with epilepsy take multiple medications in high doses that may lead to unnecessary drug exposure to unborn babies. Some medications used for epilepsy are strongly linked to birth defects.In some cases, medications may be reduced or changed before pregnancy, particularly if seizures are well-controlled. 

If pregnancy occurs unexpectedly, women should not discontinue their seizure medication until they consult with their doctors. This commonly leads to more frequent seizures, which can also harm the baby.

Seizures During Pregnancy

The frequency of seizures usually does not change significantly during pregnancy. However, some women have seizures more frequently, while others experience fewer seizures. Blood levels should be checked often. This precaution is taken because medication blood levels gradually decrease during pregnancy and, if not adjusted, can reach their lowest level around the time of delivery, resulting in breakthrough seizures. All seizures occurring during pregnancy should be reported to your doctor.

The good news is that if you have been seizure-free for at least 9 months, then you are more likely to stay seizure-free during your pregnancy.

Epilepsy and Labor and Delivery

Most pregnant women with epilepsy have normal vaginal deliveries, although cesarean sections (C-sections) in which the baby is removed through an incision in the abdomen, are required in some cases. When seizures occur during labor or delivery, C-sections are usually performed immediately.

Breastfeeding With Epilepsy

Women taking seizure drugs may breastfeed their infants. However, some of these drugs can cause babies to become very sleepy and irritable after feedings. If these effects occur, discontinue breastfeeding until you consult with your doctor.

Epilepsy Drugs and Birth Defects

Some epilepsy drugs, especially valproate or Depakote, can increase the risk of birth defects and has been linked to lower IQ in children. On the other hand, uncontrolled seizures can pose serious problems to unborn babies. Severe birth defects are rare in infants of women who receive regular prenatal care and whose seizures are managed with medication carefully. Women should never discontinue seizure medications without consulting their doctors.

Epilepsy and Hormones

Hormones influence the function of the brain throughout life. Many women have an increase in seizure frequency just before or during their menstrual periods. This is probably due to changes in estrogen and progesterone levels that normally occur during the female reproductive cycle. Many women with epilepsy have abnormal menstrual cycles, including missed periods. If missed periods occur regularly, talk to your doctor.