Epilepsy and pregnancy: how to prepare

  • December 20, 2023
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In this article
A woman with epilepsy in pregnancy and her daughter on a couch

Becoming pregnant can be very exciting, but it can also be a challenging time. There are lots of things to plan, tests to have and decisions to make. And if you have epilepsy in pregnancy, there may be some extra things to think about too. 

Studies show that women with epilepsy who don’t have separate fertility issues, can become pregnant at the same rate as women who don’t have epilepsy. And, so long as you have appropriate medical support, there’s no reason you can’t have a healthy pregnancy. 

Here’s what you need to know about epilepsy and pregnancy. 

Epilepsy and pregnancy: is it safe?

Yes, women with epilepsy can have safe and healthy pregnancies. The Epilepsy Pregnancy website, a helpful resource for women with epilepsy, points out that there’s no difference in pregnancy rates, time to get pregnant, or pregnancy outcomes for people with epilepsy, compared to those who don’t have seizures. 

That said, there are certain risks and challenges you should be aware of - but they can be managed. We’ll describe these in more detail below. 

Planning for epilepsy in pregnancy

In an ideal world, women with epilepsy who would like to get pregnant would plan in advance with the support of medical professionals. But life isn’t always like that! 

In this section, we’ll look at planning for your pregnancy if you have epilepsy. We’ll also look at what to do if you’ve just found out you’re pregnant and it wasn’t expected. 

Epilepsy and pregnancy planning

If you’ve decided that you want to get pregnant and you have epilepsy, then advanced planning will increase your chances of a healthy, safe pregnancy. 

Ideally, try to speak with your doctor and your neurologist up to 12 months before you plan to get pregnant. For women who take certain anti-seizure medication, it may be best to change their medication. Certain seizure medicines can harm your baby, so your doctor will want to change your prescription. And it can take between three and 12 months to safely switch to a new seizure medicine. 

Your doctor will also recommend that you take folic acid supplements while you’re trying to get pregnant, and throughout the pregnancy. Folic acid helps with the healthy development of your baby and is recommended for all women. But some studies have found that women who take epilepsy medication have lower levels of folic acid than other women, so your doctor might prescribe you a higher dose. 

Read more: Folic acid and epilepsy during pregnancy

Epilepsy in a pregnancy that wasn’t planned

If you have epilepsy and you’ve just found out you’re unexpectedly pregnant, it’s helpful to:

  • Book an appointment with your doctor and an epilepsy specialist as soon as possible. 
  • Keep taking your epilepsy medication. It is true that some anti-seizure medicines can cause damage to your baby, but if you stop taking them immediately, you increase your risk of seizures during pregnancy - and that can also be harmful to the baby. At your doctor’s appointment, you can make a plan for your treatment. 
  • Start taking folic acid - your doctor can prescribe it.

Are there risks with epilepsy in pregnancy?

All pregnancies come with some risk, and it’s no different for women with epilepsy. There are a few things it’s important to be aware of so you can reduce those risks as much as possible. 

Find out if you need to change your seizure medication

Certain kinds of seizure medication are known to increase the risk of developmental problems for babies who were exposed to them in the womb. They may cause physical malformations, and can also slow the child’s mental development. 

Whatever anti-seizure medicine you take, you should speak with your treatment team to work out a plan. They might:

  • Change your medicine.
  • Reduce the dose.
  • Keep you on the same medicine if they believe it’s safer than changing.

The most high risk medication for epilepsy in pregnancy is valproic acid (also known as sodium valproate, or by brand names like Depakote or Epilim). Between 9 and 12% of children who are exposed to valproic acid in the womb have malformations. 

Learn more: Risks of sodium valproate and pregnancy

Other common epilepsy medications that are at a higher risk of causing malformations include:

  • Phenobarbital (also known as phenobarbitone, or the brand name Luminal) can cause malformations in between 4 and 10% of children exposed. 
  • Phenytoin (also known as Dilantin) can cause malformations in between 3 and 12%
  • Carbamazepine (also know by brand names like Carbatrol, Epitol or TEGretol) can cause malformations in between 5 and 7%
  • Topiramate (brand names include Topamaz and Eprontia) can cause malformations in between 2 and 8%

To help put this in context, it’s believed that 3% of all children in the US are born with malformations, on average. 

Some epilepsy medications appear not to increase the risk of your child having developmental issues. These include lamotrigine (Lamictal) and levetiracetam (Keppra). Around 3% of children whose mothers took these medicines are born with malformations - which is the same as the US average. 

Unfortunately, the risk of developmental issues with many other anti-seizure drugs is not well studied. We know about the dangers of valproic acid because doctors noticed a higher number of children were born with malformations after their mothers took it during pregnancy. But it would be unethical to do an experiment where scientists intentionally exposed some fetuses to a drug and others not to see if there was a difference. 

Can pregnancy cause seizures?

Many women with epilepsy do not experience an increase in seizures in pregnancy - most have their usual number of seizures. But every pregnancy, and every woman, is different. There are a few reasons you may experience more seizures in pregnancy:

  • Tiredness and stress: It’s very normal to feel tired or stressed during pregnancy. These are well known seizure triggers
  • ‘Morning’ sickness: It’s common to experience morning sickness (which can actually happen any time of the day) throughout pregnancy. If you throw up after taking your seizure medication, it may still be on your stomach and not absorb properly. 
  • Hormonal and physical changes: Your body will go through enormous changes during pregnancy, and these may mean your body processes seizure medication less effectively. 

Severe seizures during pregnancy

There’s no evidence that many types of seizure pose a threat to your health or the baby’s health during pregnancy. If you have focal, absence, or myoclonic seizures, there’s no reason to believe these will harm your child. 

If you have tonic clonic seizures, some research has found that it can pose a health risk to the baby, particularly due to hypoxia (not getting enough oxygen) during this kind of seizure. Speak with your doctor to plan your medication and practical changes you can make around the home and routine to reduce the risks. 

What if you’re being treated with neuromodulation? 

If your seizures are being treated with neuromodulation devices - such as vagus nerve stimulation, deep brain stimulation or responsive neurostimulation - then there appears to be no risk to your child’s development. 

In fact, there’s at least one example of a woman who had a neuromodulation device fitted during her pregnancy, and this successfully reduced the number of seizures she had. 

Epilepsy and pregnancy: you’re in control

Most women with epilepsy have healthy, safe pregnancies. Although there are certain risks - particularly from some kinds of seizure medication - these can be managed. By working closely with your treatment team, you can feel in control and give yourself, and your baby, the best pregnancy possible.

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