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Epilepsy and Pregnancy - What You Should Know

Is it safe to get pregnant for women with epilepsy?
Yes. With proper care, more than 90% of women with epilepsy give birth to normal babies. Even though there is 25% risk of worsening seizures in pregnancy, with proper management this can be controlled. Convulsive seizures can be harmful to the fetus, and more so the medications, so it is important to have them under control.

Does epilepsy make it harder to get pregnant?

Possibly. Pregnancy can increase the risk of infertility because of changes in hormones and sexual dysfunction. Some medications (valproate) can contribute to polycystic ovarian disease. This is why the choice of anti-seizure medications in women of reproductive age is important.

Does pregnancy increase the risk of seizures?

Sometimes. During pregnancy, seizure frequency can increase, decrease or stay the same. About 25% of women have worsening of seizure frequency during pregnancy. Some of the reasons for increase in seizure frequency can be due to hormonal effects, non-compliance, change in therapeutic levels of anticonvulsants and metabolic or structural changes in the body.

Is there an increased risk of seizure during delivery?

Not really. Rarely, seizures can occur during delivery, especially in women with poorly controlled epilepsy. Some of the reasons include hyperventilation during delivery, stress/anxiety and pain. If a seizure occurs, IV medications are given to stop it immediately. In rare cases such as prolonged seizure or post-ictal state during labor, a C-section might be necessary.

Are anti-seizure medications dangerous to the fetus?

Mostly no. All seizure medications increase the risk of fetal malformations (birth defects), but only slightly. Convulsive seizures have more risk than medications and can cause fetal and placental trauma and lack of oxygen. The goal in pregnancy is to control seizures with the fewest necessary anti-seizure medications at the lowest doses needed, and this should be done before conception. This is why planning pregnancy is important.

Should anti-seizure medications be discontinued during pregnancy?

No. Women should discuss their medication options and plans to get pregnant with their neurologist prior to conception. However, if pregnancy was not planned, it is not wise to discontinue medications on your own as it can increase the risk of seizures even more. Immediately make an appointment with your neurologist and discuss possible changes in medications. Women with well controlled epilepsy, for example if seizure free for 2 to 5 years, can consider reducing or stopping seizure medication under the guidance of their neurologist. Women taking multiple medications can consider with their neurologist’s help limiting their treatment to one medicine if possible.

What is the drug of choice for seizures in pregnancy?

There is no medication of choice during pregnancy. All seizure medications are comparable, with the exception of valproate, which is generally to be avoided. Important factors are the number of medications being taken and their doses.

What precaution should a woman with epilepsy take before conception to avoid birth defects?

Along with being on appropriate anti-seizure medications, women who plan pregnancy should be on folic acid prior to conception and at a dose of 4 to 5 mg daily, which is higher than what is in typical prenatal vitamins. Since folic acid is important before conception, 50% of pregnancies are unplanned, and most women find out they are pregnant after 4 weeks, folic acid is recommended for every women with epilepsy of child bearing age.  

Will the baby inherit epilepsy?

Generally no. Most epilepsies are not genetic. Even genetic epilepsies are not transmitted simply so that offspring is usually not affected.

Is breastfeeding safe when on anti-seizure medications?

Yes. While most anti-seizure medicines are secreted in breast milk, exposing the baby to some amount, it is now well-accepted that the benefits of nursing outweigh potential neurologic consequences.
Authored by: Pooja Sureja MD | Selim R. Benbadis MD on 10/2014
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