About pregnancy and epilepsy

Epilepsy is a very common neurologic disorder. It affects many women during their childbearing years. About 50% of pregnancies in the United States are unplanned, but not unwanted. A woman with epilepsy must be prepared and plan for her future pregnancy to ensure the best possible outcome for her and her baby.

Since valproate can lower a child's IQ if taken by the mother during pregnancy, the US Food and Drug Administration recommends that it not be taken by women of childbearing age unless there is no alternative option. Many antiseizure medications carry some risk of birth defects, even some of the newer ones. Taking folic acid 1 mg a day before becoming pregnant and during the pregnancy can reduce the chance of having a baby with a birth defect. It may also lessen the chance of learning problems due to antiseizure medication exposure in utero. Women who want to have a baby or who are sexually active but not using any type of birth control should consult their doctor. Forms of birth control include condoms, intrauterine devices, birth control pills, or birth control implants (e.g., Implanon, Depo-Provera).

Before a pregnancy is planned, the responsible physician may want to change the seizure medication or consider reducing or stopping it. If seizures were well-controlled for the 9 months prior to pregnancy, then seizures will most likely remain well-controlled during pregnancy. Up to one-third of patients can have worsening of their seizures during pregnancy. This can be due to changes in the way the body handles the antiseizure medications, increased hormones in the body, poor sleep, or not taking the medication properly. Levels of several antiseizure medications, including lamotrigine and levetiracetam, are known to decrease during pregnancy. Increases in dose are usually needed to maintain steady levels and seizure control.

Women with epilepsy can have regular vaginal births, but there are slightly increased rates of cesarean section delivery. Pregnant women may need to take vitamin K before delivery to help prevent bleeding. Breastfeeding benefits to the child must be weighed against the additional exposure of the baby to antiseizure medications in the mother's milk. At least one study showed that breastfeeding while taking antiseizure medication is safe and does not lower a child's IQ.

Mothers with epilepsy should practice good safety measures and never bathe the baby alone or have the baby in standing water. A baby can drown in a small amount of water if the mother is confused after a seizure.

Babies born to women taking antiseizure medications are at risk for birth defects. These are obvious signs that the baby did not develop normally in utero. These may include cleft lip or palate, spina bifida, or heart defect. Some signs of abnormal development can be harder to see. If the brain did not form properly, learning problems and behavioral problems may be the only sign. These will not be obvious when the baby is born but will show up later during preschool and elementary school. Women who took antiseizure medication while pregnant should let the baby's pediatrician know and have the baby checked for development problems. Most school districts will test children as young as 2 or 3 years old, and early intervention programs and Head Start programs can be initiated.