Epilepsy and Pregnancy
Can Having Epilepsy Affect Getting Pregnant?
Epilepsy itself usually does not make it harder to become pregnant. However, certain medications used to prevent seizures might make conception more difficult for some women.
Some epilepsy treatments can also reduce the effectiveness of hormonal birth control, leading to unplanned pregnancies. Before trying to have a baby, talk with a doctor or epilepsy specialist about current medications and whether changes are needed.
How Might Epilepsy Impact Pregnancy?
Having epilepsy can raise the risk of several issues during pregnancy, especially if seizures occur. Risks include a slower fetal heartbeat, less oxygen to the baby, preterm labor, low birth weight, injuries from falls, placental abruption, or pregnancy loss.
The type and frequency of seizures can influence these risks. For example, tonic-clonic seizures (which involve muscle stiffening and jerking) can be more dangerous than other types.
Table: Possible Complications Linked to Seizures During Pregnancy
| Complication | Description |
|---|---|
| Slowed fetal heart rate | Baby’s heartbeat slows, decreasing oxygen supply. |
| Low birth weight | Baby may weigh less than normal at birth. |
| Premature birth | Baby is born before 37 weeks. |
| Placental abruption | Placenta separates early, risking the baby’s health. |
| Preterm labor | Labor starts before the baby is fully developed. |
Does Pregnancy Change How Epilepsy Shows Up?
Pregnancy affects each person differently. For most pregnant women with epilepsy, seizure frequency either stays the same or decreases. Some people may have more seizures, especially if they don’t get enough sleep or forget to take their medication. Following the treatment plan closely and getting enough rest can help reduce seizures.
What Should Be Known About Seizure Medications?
Epilepsy medicines can help control seizures but some types can increase the risk of birth defects. Problems linked to certain drugs include cleft palate, issues with the neural tube (like spina bifida), heart problems, and bone or urinary tract issues. The risks are higher if higher doses are used, or if more than one medication is taken together.
Some commonly prescribed medications, like sodium valproate, carry higher risks for birth defects. Medicines such as lamotrigine and levetiracetam are often preferred during pregnancy as they tend to have safer profiles.
People who have been seizure-free for a long time (over a year) might be able to reduce or stop medications before pregnancy, but only under a doctor’s supervision. Usually, continuing epilepsy treatment is safer than stopping medication, as uncontrolled seizures can be more harmful to the baby than the drugs.
List: Tips for Managing Epilepsy Medication During Pregnancy
- Never change or stop medication without a doctor’s advice.
- Use the lowest effective dose.
- Take medication at exactly the same time each day.
- Attend regular appointments to monitor medication levels.
What Steps Should Be Taken Before Becoming Pregnant?
Before planning a pregnancy, schedule a meeting with care providers, such as the family doctor, neurologist, epilepsy specialist, and midwife or obstetrician. This team will review seizure control and may recommend changing some treatments to safer alternatives.
Women who have frequent seizures are often advised to wait until their epilepsy is better managed. Taking medication exactly as prescribed, eating a healthy diet, avoiding drugs and alcohol, and getting enough sleep are important steps. Prenatal vitamins should be started before conception.
Why Is Taking Folic Acid Vital for Women With Epilepsy?
Folic acid helps prevent neural tube defects, such as spina bifida, in the developing baby. Neural tube defects affect the brain and spinal cord and can occur early in pregnancy before many women even know they are pregnant. Start taking folic acid supplements at least three months before becoming pregnant.
Most experts advise women with epilepsy to take at least 0.4 mg of folic acid daily; in some cases, doctors may recommend a higher dose. Taking folic acid is especially important for those using certain anti-seizure medications, such as those that can reduce folic acid levels in the body.
What Happens During Prenatal Appointments?
Women with epilepsy who are pregnant have more frequent check-ups than average. At every visit, doctors check blood pressure and weight. Blood tests monitor drug levels, as these can change during pregnancy.
Doctors may order extra ultrasound scans to monitor the baby’s growth. Sometimes, providers recommend vitamin K supplements in the last month of pregnancy. This can help prevent bleeding problems in babies whose mothers take certain epilepsy medications.
Table: Common Checks During Prenatal Visits
| Test/Check | Purpose |
|---|---|
| Blood pressure | Detects high blood pressure or preeclampsia. |
| Blood tests | Monitors medication levels, liver function, and overall health. |
| Ultrasounds | Tracks baby’s growth and health. |
| Weight check | Assesses healthy weight gain. |
| Vitamin K advice | May help the baby avoid bleeding problems. |
What Should Be Done if a Seizure Occurs During Pregnancy?
If a seizure happens during pregnancy, report it to a doctor right away. The health care team may need to adjust medications or monitor the baby more closely. Sometimes, especially in the third trimester, doctors may want to observe the baby soon after a seizure. Most women who have occasional seizures during pregnancy still deliver healthy babies, but safety monitoring is important for both mother and child.
How Can Women With Epilepsy Check on Their Baby’s Health?
Regular monitoring is important in pregnancies where the mother has epilepsy. This may include more frequent ultrasounds and extra tests to check that the baby is developing well.
If any concerns arise, such as unusual symptoms or changes in the baby’s movement, discuss them with the health care team right away. Open communication helps catch problems early.
What Should Women With Epilepsy Know About Giving Birth?
Most women with epilepsy have safe, regular births without complications. Seizures during labor are not common. If a seizure happens in labor, doctors can give medication through a vein (IV) right away to stop it. In rare cases, if a seizure is long or hard to control, doctors may recommend a cesarean section (C-section).
After delivery, medication doses might be adjusted, as the body returns to its non-pregnant state, and drug needs may change. Talk with a care provider about restoring medication to pre-pregnancy doses, if needed.
Is Breastfeeding Possible With Epilepsy?
Most women with epilepsy can breast-feed their babies, even when taking anti-seizure drugs. Breast milk is good for the baby, and the small amount of medicine that gets into breast milk is often safe.
Discuss breastfeeding plans with the medical team. In some cases, mothers may be advised to breast-feed right before taking their medication, so the drug level in breast milk is lower. If there are any concerns about medication effects or if the baby is sleepy or feeding poorly, talk to the doctor or midwife.
