Topic Overview

Most women who have epilepsy
deliver healthy babies. But the risk of birth defects, stillbirth, and seizure-related
problems is higher for babies born to women with epilepsy. Most antiepileptic medicines
increase the risk even more.

If you have epilepsy and become pregnant, stopping medicine
treatment is not always the best solution. Having seizures during pregnancy can
also harm the baby. And pregnancy causes changes in your body that may increase
the frequency of seizures.

The following information is based on guidelines from the American
Academy of Neurology.footnote 1, footnote 2

Before you become pregnant

Before you become pregnant, talk with your doctor
about your epilepsy treatment. Seizures or seizure medicine may cause damage to
the baby very early in your pregnancy, before you even know that you are
pregnant. Your doctor will help you consider whether potential seizures or
continued use of antiepileptic medicine poses the greater risk to your baby.

In general, the recommendation is to only use one medicine for epilepsy and to use it at the lowest possible dose to avoid potential problems from the medicine. Medicines may not harm a baby as much as the pregnant woman having seizures may.

If you are not yet pregnant but are planning to become pregnant,
stopping medicine might be an option if you have been seizure-free for several
years. Your doctor may suggest a trial run without the medicine before you
become pregnant. Experts recommend that this trial run take place at least 6
months before the pregnancy so that you and your doctor can see the results of
stopping your treatment. If you begin having seizures, you may need to go back
on medicine.

While you are pregnant

If you need to stay on medicine during your pregnancy, your doctor may suggest some changes in your treatment that reduce the risk of birth
defects. These changes may include:

  • Switching to a medicine that is safer for the
    baby.
  • Taking a single medicine.
  • Changing the medicine
    dosage.
  • Having blood tests to make sure you have the right levels of seizure medicine in your body.
  • Taking
    folic acid or other supplements before you
    conceive and during certain times of your pregnancy. (Folic acid reduces the
    risk of some birth defects.)

You may put yourself and your
baby at greater risk if you change, reduce, or stop taking your medicine while you are
pregnant. Talk with your doctor first.

Other concerns

  • During your pregnancy, you may need more
    frequent checkups to monitor the baby’s condition and blood tests to monitor
    your drug levels.
  • After your baby is born, he or she may need to
    take extra vitamin K for a short period of time. (Some antiepileptic medicines
    can cause a temporary blood disorder in newborns that makes it difficult for
    their blood to clot normally. Vitamin K can help reverse this
    problem.) Your doctor may recommend that you take vitamin K during your pregnancy.
  • Breastfeeding while you are taking antiepileptic
    medicine is usually safe. But talk to your doctor about any concerns you have.
    If you are taking a barbiturate (such as phenobarbital) to control your
    seizures, breastfeeding may make the baby drowsy or irritable, because the
    drug may get into your breast milk.

If you have epilepsy and find out that you are pregnant, consult your
doctor immediately. Do not stop taking your medicine without first talking to
your doctor.

Related Information

References

Citations

  1. Harden CL, et al. (2009). Practice parameter update: Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology, 73(2): 133-141.
  2. Harden CL, et al. (2009). Practice parameter update: Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): Vitamin K, folic acid, blood levels, and breastfeeding: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology, 73(2): 142-149.

Credits

ByHealthwise Staff
Primary Medical Reviewer John Pope, MD – Pediatrics
Specialist Medical Reviewer Steven C. Schachter, MD – Neurology

Current as ofOctober 9, 2017

Current as of:
October 9, 2017