Download Pregnancy and Seizures

F.E. Dreifuss Comprehensive Epilepsy Program
Department of Neurology
______________________________________________________________________________
PREGNANCY AND SEIZURES
Will I have trouble getting pregnant because I have epilepsy?
Most women with epilepsy are able to become pregnant but some women have difficulty. If you
have difficulty becoming pregnant, discuss it with your doctor. Hormones and other medications
can be used to help you become pregnant.
Does having epilepsy require extra care when I am pregnant?
Most women with epilepsy have a normal pregnancy. But, these pregnancies are considered to be
“high risk” by obstetricians, so early and continuous prenatal care is very important.
Will I have more seizures during pregnancy?
Pregnancy does not affect seizures for most women. However, some women have more frequent
seizures during their pregnancy, especially during the first or third trimester. During pregnancy,
the blood level of seizure medications may decrease due to hormonal changes and increasing
body size. This can increase the likelihood of seizures. The blood level of seizure medications
may need to be checked periodically, which you should discuss with your doctor.
Will I have more problems during pregnancy because I have epilepsy?
Women with epilepsy are slightly more likely to have morning sickness, vaginal bleeding, and
early or premature labor and delivery.
Will I have a normal healthy baby?
There is a better than 95% chance that your baby will be perfectly healthy. About 2% of babies
born to mothers without epilepsy have some type of birth defect. Babies born to women with
epilepsy have only about a 4% chance of having a birth defect. Therefore, it is very likely that
you will have a healthy baby. Proper prenatal care reduces the risk of birth defects.
Can antiepileptic drugs affect my baby?
Taking antiepileptic drugs can increase the risk of birth defects. However, seizures can also
cause problems for the baby. Each mother and neurologist must weigh the risks from seizures
compared to the risks from antiepileptic drugs. The risk from either is small but the risk from
seizures is usually greater than the risk from medications. Therefore, most women should
continue to take antiepileptic drugs during pregnancy.
What is the most important thing I can do before becoming pregnant to reduce the risk of
birth defects?
Folic acid (also called folate) is a vitamin that helps prevent birth defects in all women, but
especially those with epilepsy. It is available in most stores and pharmacies. Taking 1 mg to 5
mg of folic acid each day is recommended for all women with epilepsy who may become
pregnant. Routine prenatal vitamins may also reduce the risk of birth defects.
1
What else can I do to reduce the risk of birth defects?
Discuss becoming pregnant with your neurologist and obstetrician before you become pregnant.
Eat a good diet and get adequate sleep. Take prenatal vitamins and your medications regularly,
as prescribed. Avoid the triggering factors that can cause seizures. Get early and continued
obstetric care. Discuss with your neurologist whether to check drug blood levels periodically.
Can I have a normal vaginal delivery?
Most mothers are able to deliver their babies in the normal manner. Having epilepsy does not
usually require any special procedures for delivering the baby.
What if I have seizures when I deliver the baby?
Surprisingly few women with epilepsy have seizures during delivery but it can happen. Mild
seizures, such as complex partial seizures, do not usually affect the baby or delivery. Generalized
convulsions can cause difficulties if you are too sleepy to participate after the convulsion. In the
unlikely event that you have a convulsion during delivery, you might be given an intravenous
infusion of medication to stop seizures and you might have to undergo a Caesarian section to
protect the baby.
Can I breast feed my child?
You must weigh the advantage of breast feeding against the possible risks to the baby from
medication. This is a personal decision. Most antiepileptic drugs pass into breast milk, so the
baby will get some exposure to the drug. This raises the possibility that the baby will be exposed
to antiepileptic drugs. It is not known whether antiepileptic drugs affect development. However,
the baby was exposed to the drug throughout the pregnancy, which is a more important time for
brain development so exposure after that seems less important. On the other hand, some mothers
find breast feeding is important for bonding or for nutritional reasons.
Will I drop my baby if I have a seizure while breast feeding?
It is possible that you would drop your baby during breast feeding if you have a seizure.
Therefore, you should breast feed in a position that will not harm the baby if you have a seizure,
such as while lying down or with the baby propped on a pillow.
What should I remember as a care taker of a baby when I have uncontrolled epilepsy?
Always heed an aura or the warning sign that you could have before the seizures. If you have
uncontrolled seizures, care should be taken when carrying the child, changing diapers, breast
feeding and bathing the child. Breast feeding and diaper changing should be done on the floor or
a surface which is low and soft surfaces where there is less chance that the child can fall. Do not
bathe the baby in a bath tub of water or with the drain plugged.
How can I help researchers find out if seizure medications cause birth defects?
Call the North American Antiepileptic Drug Pregnancy Registry at 888-233-2334. During a brief
phone call, they will ask what mediations you take and other simple information. They will call
you after you deliver your baby to determine whether any problems occurred. This registry has
already helped us know the risk of birth defects with lamotrigine and a few other drugs. As more
women call the registry, we will be able to give you better information about other drugs.
2
Rev 2/15/11
3