Epilepsy and pregnancy: What you need to know

Epilepsy during pregnancy raises special concerns. While most people 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 become pregnant?

Epilepsy alone doesn't have an effect on your ability to get pregnant. Some drugs used to treat seizures might make it more difficult to become pregnant, though. And certain anti-seizure medications can reduce how well hormonal birth control methods work. If you're thinking about having a baby, ask your health care provider if you need to make changes to your medication.

How does epilepsy affect pregnancy?

There is a risk of the following problems when a seizure happens during pregnancy:

• Slowing of the fetal heart rate
• Decreased oxygen to the fetus
• Preterm labor
• Low birth weight
• Premature birth
• Trauma to the mother, such as a fall, that could lead to fetal injury, premature separation of the placenta from the uterus (placental abruption) or even fetal loss

How high your risk is for these concerns depends on the type of seizure you have. Talk to your health care provider about your level of risk.

Does epilepsy change during pregnancy?

Everyone's body reacts differently to pregnancy. For most pregnant people who have epilepsy, the number of seizures remains about the same, or seizures become less frequent. For others, particularly those who are sleep deprived or don't take medication as directed, pregnancy can increase the number of seizures.

What about medication?

The medication you take during pregnancy can affect your baby. Birth defects — including cleft palate, neural tube defects, skeletal problems, and heart and urinary tract problems — are some of the 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 2 to 4 years, you might be able to taper off medications before you conceive to see if you remain seizure-free. Talk to your health care provider before you stop taking any of your medications.

For most people, it's best to continue epilepsy treatment during pregnancy. To minimize the risks, your health care provider will prescribe the safest medication and dosage that's effective for your type of seizures. Seizure medication levels may be monitored throughout your pregnancy.

How should I prepare for pregnancy?

Before you try to become pregnant, make an appointment with the health care provider who will handle your pregnancy. You may want to talk with a provider who specializes in high-risk pregnancy. Meet with other members of your health care team, too, such as your primary care provider and your neurologist. They'll evaluate how well you're managing your epilepsy. Your providers may also consider treatment changes you might need to make before you become pregnant.

If you have frequent seizures before you become pregnant, 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 medication without talking to your health care provider. Uncontrolled seizures likely pose a greater risk to your baby than medication does.

It's also important to make healthy lifestyle choices:

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

Why is folic acid important?

Folic acid helps prevent serious problems with the brain and spinal cord called neural tube defects. The American College of Obstetricians and Gynecologists recommends women with epilepsy take a daily multivitamin that includes 0.4 milligrams of folic acid. Your health care provider may suggest a higher dose based on your situation. It's best to start taking a folic acid supplement three months before you get pregnant.

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. You might need frequent blood tests to monitor your medication level.

If you're taking anti-seizure medications, your health care provider may advise that your baby be given vitamin K at the time of birth. This can help prevent rare bleeding problems that have been found in some infants born to people who have epilepsy. In some cases, taking vitamin K during the last month of pregnancy might be recommended.

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

Seizures can be dangerous, but many people who have seizures during pregnancy deliver healthy babies. Report a seizure to your health care provider right away. Your medication might need to be changed. If you have a seizure in the last few months of your pregnancy, your health care provider may 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 growth and well-being. Your health care provider might suggest other prenatal tests, as well.

What about labor and delivery?

Most people who have epilepsy deliver their babies without problems. Seizures don't often happen during labor. If you have a seizure during labor, it might be stopped with intravenous medication. If the seizure lasts a long time, your health care provider might deliver the baby by C-section.

If your anti-seizure medication dosage is changed for pregnancy, talk to your health care provider about returning to your pre-pregnancy levels shortly after your baby is born. This will help keep your seizures under control and your medication at safe levels.

Will I be able to breast-feed my baby?

Breastfeeding is encouraged for most people who have epilepsy, even those who take anti-seizure medication. Discuss breastfeeding with your health care provider ahead of time. You may need to take your medication after a feeding. And sometimes a change in medication is necessary.