Epilepsy and pregnancy: What you need to knowThe 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, such as polycystic ovarian syndrome, that might make it harder to conceive. Medication might be an issue as well. Some drugs used to treat seizures might contribute to infertility.
Keep in mind, however, that certain seizure medications can also reduce the effectiveness of hormonal birth control methods.
How does epilepsy affect pregnancy?
Women who have epilepsy face a higher risk of pregnancy-related complications, including:
- Severe morning sickness
- 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
- Failure to progress during labor and delivery
- Babies with congenital anomalies
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 the primary concern with seizure medications. In addition, taking certain seizure medications, such as those that contain valproate, or more than one seizure medication during pregnancy can increase the risk that your baby will have impaired cognitive development. Valproate products include valproate sodium (Depacon), divalproex sodium (Depakote, Depakote ER) and valproic acid (Depakene, Stavzor). Other problems caused by seizure medications might include minor birth defects that affect the baby's appearance, such as wide-set eyes or a short upper lip — though it isn't clear whether this is related to the drugs or the disease.
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 more than one seizure medication is taken, particularly at high doses. Without medication, however, uncontrolled seizures might 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. Your health care provider might recommend avoiding use of valproate or use of more than one seizure medication during the first trimester of pregnancy or throughout pregnancy. Keep in mind that no single medication is best for everyone.
During pregnancy and shortly after delivery, the concentration of seizure medication in your blood might decrease — putting you at greater risk of seizures. As a result, your health care provider will monitor the concentration of seizure medication in your blood and adjust the dosage as needed. 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.
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 might 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:
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- 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.
- Avoid exposure to chemicals such as those found in pesticides, paints and oven cleaners.
See more In-depth
- Pregnancy issues. Epilepsy Foundation. http://www.epilepsyfoundation.org/living/women/pregnancy/weipregnancy.cfm. Accessed March 31, 2011.
- O'Brien MD. Management of epilepsy in women. Postgraduate Medical Journal. 2005;81:278.
- Pregnancy and epilepsy. Epilepsy Foundation. http://www.epilepsyfoundation.org/answerplace/Life/adults/women/Professional/pregnancy.cfm. Accessed March 31, 2011.
- Schachter SC. Management of epilepsy and pregnancy. http://www.uptodate.com/home/index.html. Accessed March 31, 2011.
- Schachter SC. Risks associated with epilepsy and pregnancy. http://www.uptodate.com/home/index.html. Accessed March 31, 2011.
- Sukumaran SC, et al. Polytherapy increases the risk of infertility in women with epilepsy. Neurology. 2010;75:1351.
- Sethi NK, et al. Pregnancy and epilepsy — when you're managing both. The Journal of Family Practice. 2010;59:675.
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- Harden CL, et al. Management issues for women with epilepsy — Focus on pregnancy (an evidence-based review): II. Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. 2009;50:1237.
- Harden CL, et al. Management issues for women with epilepsy — Focus on pregnancy (an evidence-based review): I. Obstetrical complications and change in seizure frequency: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. 2009;50:1229.
- Harms RW (expert opinion). Mayo Clinic, Rochester, Minn. April 12, 2011.
- Borthen I, et al. Delivery outcome of women with epilepsy: A population-based cohort study. BJOG: An International Journal of Obstetrics and Gynaecology. 2010;117:1537.
- Nadebaum C, et al. Language skills of school-aged children prenatally exposed to antiepileptic drugs. Neurology. 2011;76:719.
- Kuczkowski KM. Labor analgesia for the parturient with neurological disease: What does an obstetrician need to know? Archives of Gynecology and Obstetrics. 2006;274:41.
- FDA Drug Safety Communication: Children born to mothers who took valproate products while pregnant may have impaired cognitive development. U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/ucm261543.htm. Accessed July 11, 2011.