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Epilepsy and pregnancy: What you need to know

The combination of epilepsy and pregnancy might seem risky, but the odds are in your favor. Find out how to promote a healthy pregnancy.

By Mayo Clinic staff

Years ago, women who had epilepsy were often discouraged from getting pregnant. Today, that's no longer the case. Thanks to early and regular prenatal care, more than 90 percent of pregnant women who have epilepsy deliver healthy babies, according to the Epilepsy Foundation.

If you have epilepsy and are considering pregnancy, here's what you need to know.

Does epilepsy make it more difficult to conceive?

Some women who have epilepsy have menstrual irregularities and other gynecological problems that may make it harder to conceive. Medication may be an issue as well. Some drugs used to treat seizures may contribute to infertility.

How does epilepsy affect pregnancy?

Women who have epilepsy face a higher risk of pregnancy-related complications, including:

  • Severe morning sickness
  • Anemia
  • Vaginal bleeding during and after pregnancy
  • Premature separation of the placenta from the uterus (placental abruption)
  • High blood pressure and excess protein in the urine after 20 weeks of pregnancy (preeclampsia)
  • Premature birth
  • A low birth weight baby

Does epilepsy change during pregnancy?

Every woman reacts to pregnancy differently. For most pregnant women who have epilepsy, seizures remain the same. For a few, seizures become less frequent. For others — particularly women who have poorly controlled epilepsy — pregnancy increases the number of seizures.

What about medication?

Any medication you take during pregnancy can affect your baby. Birth defects — including cleft palate, neural tube defects, skeletal abnormalities, and congenital heart and urinary tract defects — are a major concern with seizure medications.

For babies whose mothers take seizure medication, the risk of birth defects is 4 to 8 percent — compared with 2 to 3 percent for all babies — according to the Epilepsy Foundation. The risk seems to be highest when multiple seizure medications are taken. But without medication, uncontrolled seizures may deprive the baby of oxygen. Seizures can also increase the risk of miscarriage or stillbirth.

A few women can safely taper off their medication before pregnancy. For most women, however, it's best to continue treatment during pregnancy. To minimize the risks for you and your baby, your health care provider will prescribe the safest medication and dosage that's effective for your type of seizures. No single medication is best for everyone.

As your pregnancy progresses and your blood volume increases, your kidneys may remove the seizure medication from your system more quickly than usual. As a result, it's often best to increase the dose of medications during pregnancy, despite concerns about impact on the baby. Severe nausea and vomiting during early pregnancy may upset the balance as well. You may need frequent dosage adjustments to maintain seizure control. Remember, uncontrolled seizures pose a greater risk to your baby than does any medication.

What does my epilepsy mean for my baby?

Beyond the effects of medications, babies born to mothers who have epilepsy also have a slightly higher risk of developing seizures as they get older. Other problems may include minor birth defects that affect the baby's appearance, such as wide-set eyes or a short upper lip. Developmental delays are possible as well.

What should I do to prepare for pregnancy?

Before you try to conceive, schedule an appointment with the health care provider who'll be handling your pregnancy. Also meet with other members of your health care team, such as your family doctor or neurologist. They'll evaluate how well you're managing your epilepsy and consider any treatment changes you may need to make before pregnancy begins. Take your seizure medication exactly as prescribed. Don't adjust the dose or stop taking the medication on your own.

It's also important to make healthy lifestyle choices. For example:

  • Eat a healthy diet.
  • Take prenatal vitamins.
  • Include physical activity in your daily routine.
  • Keep stress under control.
  • Get enough sleep.
  • Avoid smoking, alcohol and illicit drugs.
  • Limit the amount of caffeine in your diet.
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References
  1. Pregnancy issues. Epilepsy Foundation. http://www.epilepsyfoundation.org/living/women/pregnancy/weipregnancy.cfm. Accessed April 22, 2009.
  2. O'Brien MD. Management of epilepsy in women. Postgraduate Medical Journal. 2005;81:278.
  3. Pregnancy and epilepsy. Epilepsy Foundation. http://www.epilepsyfoundation.org/answerplace/Life/adults/women/Professional/pregnancy.cfm. Accessed April 22, 2009.
  4. Schachter SC. Management of epilepsy and pregnancy. http://www.uptodate.com/home/index.html. Accessed April 23, 2009.
  5. Schachter SC. Risks associated with epilepsy and pregnancy. http://www.uptodate.com/home/index.html. Accessed April 23, 2009.
  6. Harms RW (expert opinion). Mayo Clinic, Rochester, Minn. May 6, 2009.

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Aug. 1, 2009

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