Pregnancy

Most women with epilepsy have healthy babies and the risks involved in their pregnancies are the same as for any pregnancy. Women with epilepsy, however, should be aware that there are special considerations related to pregnancy. If at all possible, a woman who has epilepsy should consult with her doctor before becoming pregnant to plan for the healthiest possible pregnancy. Pregnancy can affect the way your body is using your seizure medication and/or it could affect the pattern or frequency of your seizures. There is also a slightly higher risk that having epilepsy and/or taking seizure medication will affect the fetus.

Frequently asked questions regarding pregnancy and women with epilepsy.

Will I have difficulty getting pregnant?

While women with epilepsy have fewer children and a lower fertility rate than those in the general population, there has been an increase in pregnancies in women with epilepsy in recent years. Likely, this increase has been influenced by both the improved control of seizures and a better understanding of epilepsy resulting in an increasing numbers of women with epilepsy developing relationships.

Personal choices as well as a higher rate of menstrual irregularities and other gynecological problems resulting from seizure medication are likely also factors in the lower rate of pregnancies in women with epilepsy.

The temporal lobe of the brain is associated with the areas of the brain that regulate hormones in the body. If a woman experiences seizures that occur in the temporal lobe, there appears to be a higher incidence of reproductive disorders such as polycystic ovaries (many cysts on the ovaries), early menopause, and irregular or no ovulation. All of these conditions could make getting pregnant more difficult.

Seizure medication can also affect how the body regulates hormones. This can also result in reproductive changes in the body.

Do seizures change during pregnancy?

Most women have no change in seizure frequency during pregnancy. Some even have a reduction in seizures. Others do, however, experience an increase in seizures when they are pregnant. With the physical changes that occur in the body during pregnancy, seizure medication levels in the blood may fluctuate resulting in a change in seizures. Other factors that can affect seizures during pregnancy include:
- high estrogen levels during pregnancy
- an increase in situations that are known to trigger seizures such as higher stress levels and loss of sleep
- a reduction in seizure medication due to a woman's concern over the possibility of harmful effects to the fetus. Changes in seizure medication should only be done on your doctor's advice as the risks associated with uncontrolled seizures are higher than those associated with taking seizure medication.

 Is there a greater risk of complication during pregnancy?

Yes, complications during pregnancy and labour are slightly higher in women with epilepsy. Both seizure medication and uncontrolled seizures pose risks during pregnancy. The risks associated with uncontrolled seizures are considered to be higher than those associated with taking seizure medication. While most seizures do not have harmful effects on the fetus, having a tonic clonic seizure can increase the risk of miscarriage, trauma to the abdomen, and/or oxygen deficiency to the fetus.

In women with epilepsy, there is also a small increase in the risk of premature labour and delivery, morning sickness, vaginal bleeding, and placental detachment. There is also a slight increase in fetal loss late in the pregnancy, stillbirths, and the need for a caesarean section in women with epilepsy. In general, however, a woman with epilepsy will have a normal pregnancy, labor and delivery.

Having a seizure during delivery is generally not dangerous but it may result in a more difficult delivery. It is recommended that you continue to take seizure medication up to the time of and during labour. It is important that you take your seizure medication with you to the hospital in case of a lengthy labour and that you inform staff on the hospital ward that you have epilepsy.

The risk of a baby developing internal bleeding within the first 24 hours after birth is also slightly higher if the mother has epilepsy and is taking certain seizure medication. The risk of this occurring is low and doctors often prescribe vitamin K in the weeks prior to delivery as a preventative measure. Often newborns are given vitamin K following birth to ensure proper blood clotting.           

Are seizure medication levels affected by pregnancy?

With physical changes in the body during pregnancy, seizure medication levels may decrease during pregnancy. Reasons for this include water retention that can create an increased volume of distribution, a faster metabolism, a decrease in absorption, and faster clearance from the body. Frequent blood tests to monitor the drug levels in your blood may be necessary. Seizure medication levels can also be influenced by hormonal change during the postpartum period following delivery. It is important that blood levels continue to be monitored following pregnancy as well. 

Can seizure medication harm the fetus?

Some types of seizure medication can carry the risk of causing harm to a fetus. Polytherapy, or treatment using more than one seizure medication, has a higher risk of causing harm than does monotherapy, or the use of one seizure medication.

In recent years, however, there has been a decrease in the risk of birth defects in children of women with epilepsy. This has been partially attributed to an improvement in the available seizure medication, a decreased use of polytherapy in the treatment of pregnant women, and an increased use of folic acid as prescribed by the doctor. Folic acid is thought to prevent birth defects and is recommended for all women of childbearing age.

As the greatest risk of possible birth defect occurs in the first trimester of pregnancy, it is advised that you talk to your doctor prior to becoming pregnant.

Harmful effects of seizure medication to the fetus could occur in the early weeks of pregnancy before pregnancy is medically confirmed. Planning for pregnancy will allow you to work with your doctor to establish the best possible treatment for the health of both you and your baby.

If you discover that you are pregnant and have not discussed this with your doctor, do so as soon as possible. Changes in seizure medication and/or dosages as well as vitamin supplements may be may be required. 

It is essential that you continue to take seizure medication as prescribed by your doctor during your pregnancy. Sudden discontinuation of medication can result in withdrawal seizures or status epilepticus, a life-threatening condition, and the risks to the fetus of having uncontrolled seizures are considered to be higher than those associated with taking prescribed seizure medication.

Following birth, babies sometimes experience withdrawal symptoms from the mother’s seizure medications but these symptoms typically wear off over a few days or weeks and do not cause long-term effects.

If I have a seizure, will it harm the fetus?

While evidence suggests that having brief seizures or partial seizures do not harm the fetus, a prolonged seizure carries the risk of causing harm. For example, having a tonic clonic seizure can increase the risk of miscarriage, trauma to the abdomen, and/or oxygen deficiency to the fetus. 

Will my baby be healthy?

In general, women with epilepsy have a greater than 90 percent chance of having a healthy baby.

There is, however, a greater risk of having a child with a birth defect in women with epilepsy than in the general population. The rate is 2 to 3 percent of having a child with a birth defect in the general population, and 4 to 6 percent in women with epilepsy who are being treated with seizure medication during pregnancy. The percentage may be higher if a woman with epilepsy is taking more than one seizure medication.

This increased risk of having a child with a birth defect may be the result of a number of factors including the effects of seizure medication and the influence of inherited genetic traits. Seizures can also harm the fetus.Though rare, birth defects can include major malformations such as spina bifida (or malformation of the spinal cord) or other neurological problems, heart abnormalities, and cleft lip/ palate. Minor malformations such as differences in the shape of fingers or widely spaced eyes can also occur.

All women should avoid alcohol, street drugs, and cigarette smoking during pregnancy.

Will my child have epilepsy?

There is only a slightly higher risk of a child developing epilepsy if a parent has epilepsy. The risk of a child having unprovoked seizures is one to two percent in the general population and approximately six percent if a parent has epilepsy.

Can I breast-feed?

Breast-feeding is generally safe and recommended for women with epilepsy. Seizure medication levels in the breast-milk tend to be of low concentration with no adverse side effects. Some seizure medications, however, can cause drowsiness or irritability in a breast-fed baby and your neurologist or obstetrician may recommend that breast-milk be supplemented with bottle feedings. It is important to discuss breast-feeding with your doctor to establish the healthiest approach for your child.