Epilepsy and pregnancy: What you need to know

Epilepsy during pregnancy raises special concerns. While most women who have epilepsy deliver healthy babies, you might need special care during your pregnancy. Here's what you need to know.

Does epilepsy make it more difficult to conceive?

Some drugs used to treat seizures might contribute to infertility. However, certain anti-seizure medications can also reduce the effectiveness of hormonal birth control methods.

How does epilepsy affect pregnancy?

Seizures during pregnancy can cause:

Slowing of the fetal heart rate Decreased oxygen to the fetus Fetal injury, premature separation of the placenta from the uterus (placental abruption) or miscarriage due to trauma, such as a fall, during a seizure Preterm labor Premature birth

Does epilepsy change during pregnancy?

All women's bodies react differently to pregnancy. For most pregnant women who have epilepsy, seizures remain the same. For a few, seizures become less frequent. For others, particularly women who are sleep deprived or don't take medication as prescribed, pregnancy increases the number of seizures.

What about medication?

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 a few potential side effects associated with anti-seizure medications. The risk seems to increase with higher doses and if you take more than one anti-seizure medication.

If you haven't had a seizure for nine months before you conceive, you're less likely to have a seizure during your pregnancy. If you haven't had a seizure for two to four years, you might be able to taper off medications before you conceive and see if you remain seizure-free. Talk to your health care provider before discontinuing your medications.

For most women, however, it's best to continue treatment during pregnancy. To minimize the risks for you and your baby, your doctor will prescribe the safest medication and dosage that's effective for your type of seizures and monitor your blood levels throughout your pregnancy.

What does my epilepsy mean for my baby?

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.

How should I prepare for pregnancy?

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 treatment changes you might need to make before pregnancy begins.

If you have frequent seizures before you conceive, you might be advised to wait to get pregnant until your epilepsy is better controlled.

Take your anti-seizure medication exactly as prescribed. Don't adjust the dose or stop taking the medication on your own. Uncontrolled seizures likely pose a greater risk to your baby than does any medication.

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

Eat a healthy diet. Take prenatal vitamins. Get enough sleep. Avoid smoking, alcohol, illegal drugs and caffeine.

Do I need more folic acid than other pregnant women do?

Folic acid helps prevent neural tube defects, serious abnormalities of the brain and spinal cord. Because some seizure drugs affect the way the body uses folic acid, your health care provider will recommend a high-dose folic acid supplement — ideally starting three months before conception.

What can I expect during prenatal visits?

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 level.

If you're taking anti-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.

What if I have a seizure when I'm pregnant?

Seizures can be dangerous, but many mothers who have seizures during pregnancy deliver healthy babies. Report the seizure promptly to your health care provider. He or she might adjust your medication. If you have a seizure in the last few months of your pregnancy, your health care provider will monitor your baby at the hospital or clinic.

How can I make sure my baby is OK?

Your health care provider will monitor your baby's health throughout the pregnancy. You might have frequent ultrasounds to track your baby's development. Your health care provider might recommend other prenatal tests, as well.

What about labor and delivery?

Most pregnant women who have epilepsy deliver their babies without complications. Women who have epilepsy might be able to use the same methods of pain relief during labor and delivery as other pregnant women.

Seizures don't commonly occur during labor. If you 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, you're more likely to have a seizure during delivery. Your health care provider will review the best delivery method with you to avoid increased risk of seizures during your delivery.

If your anti-seizure medication dose is altered for pregnancy, talk to your health care provider about returning to your pre-pregnancy levels shortly after delivery to continue keeping your seizures under control and your medication at safe levels.

Will I be able to breast-feed my baby?

Breast-feeding is encouraged for most women who have epilepsy, even those who take anti-seizure medication. Discuss adjustments you'll need to make with your health care provider ahead of time.

He or she might recommend taking your medication after a feeding. Sometimes a change in medication is recommended.