Epilepsy and Pregnancy

Epilepsy is a chronic disorder or group of disorders characterized by recurrent, unpredictable seizures. A seizure is a temporary physiological dysfunction of the brain, in which neurons will produce excessive electrical discharge. Because it is a chronic condition, many women want to know about epilepsy during pregnancy, and how it may affect their baby.

What are the Symptoms of Epilepsy During Pregnancy?

Unfortunately, some of the symptoms of epilepsy are similar to the symptoms of pregnancy.
Here is a quick look at some of the symptoms of epilepsy: 

Will My Epilepsy Change During Pregnancy?

The National Institute of Neurological Disorder and Stroke (NINDS) estimates epilepsy affects 1% of the United States population (about 2.5 million people). It is estimated that about 1/3-1/2 of women with epilepsy will have more frequent seizures during pregnancy.
The likely reason for the increase in seizures is anticonvulsant medications. Anticonvulsant medications tend to work differently during pregnancy, and as a result, your doctor might see the need to change your medication during pregnancy.
There is also the added difficulty of nausea, which may cause the medication to be thrown up before it can properly be absorbed into the body.

Does Epilepsy During Pregnancy Affect My Baby?

The type of seizure you experience with your epilepsy can cause different degrees of complications. If you experience partial or absence seizures, the risk to the baby is minimal.  If you suffer from a tonic-clonic (grand mal) form of seizure, the risk of injury to the baby and mother is increased.

During a tonic-clonic seizure, there is a temporary interruption of breathing; although this interruption rarely affects the mother, it can lead to oxygen deprivation in your baby. Additionally, your baby’s heart rate can slow for as long as 30 minutes after a tonic-clonic seizure.
This form of seizure also increases the risk of trauma to the baby. Tonic-clonic seizures present the greatest risk during the last trimester when the baby’s brain is larger and needs more oxygen.

What are the Risks of Epilepsy During Pregnancy?

Epilepsy can affect pregnancy in a variety of ways.  If seizures occur during pregnancy, a number of complications can occur affecting the baby including:

  • Fetal heart rate deceleration
  • Fetal injury
  • Premature separation of the placenta from the uterus
  • Miscarriage due to trauma experienced during seizures
  • Preterm labor
  • Premature birth

Anticonvulsant Medications During Pregnancy

A primary concern for expecting mothers with epilepsy is the effect the medication can have on the baby. Epileptic women have a 4-6 % chance of having a baby born with a birth defect as a result of taking anticonvulsant drugs.  Some are mild defects such as small fingers and toenails, which your baby is likely to grow out of.
However, there are more major birth defects such as spina bifida, cleft lip, neural tube defects, and heart abnormalities. You should consult your doctor about your anticonvulsant medication when trying to become pregnant. They may recommend changing your medication or lowering the dosage of your current medication.
Under no circumstances should you stop taking your medication without consulting a doctor.

Precautionary Measures

There are steps that should be taken if you are epileptic and want to ensure the healthiest pregnancy possible. Preconception counseling should be done with a doctor before you are pregnant. Your doctor will review your medical history in order to determine if a change in your anticonvulsant medication is needed.

When taking anticonvulsant medications you should speak with your doctor about taking folic acid.
Taking folic acid before and during pregnancy can increase your baby’s health.  Anticonvulsant medications can interfere with the folic acid levels in the body, and low levels of folic acid can lead to neural tube defects. Studies have shown that taking folic acid during the first three months of pregnancy decreases the risk of Spina Bifida.

However, it is always important to consult your doctor before taking folic acid, as it can interact with some anticonvulsant medications, making them less effective and increasing your chances of having a seizure.

What to Do After Birth

Labor and birth can put a tremendous amount of stress on the body affecting the health and well-being of the mother.  Studies have shown that during the two days following the birth of the baby, women with epilepsy are more likely to have a seizure.
Contributing factors as to why this may occur include:

  • Sleep deprivation
  • Hyperventilation
  • Stress
  • Physical pain
  • Failure/inability of the women to take medications

It is important for the mother to get plenty of rest, remain stress-free, and take her medications as prescribed by her doctor. Getting help from family and friends or using a postpartum doula are some ways to reduce stress.

Can I Breastfeed if I am Epileptic?

A large number of women with epilepsy are encouraged to breastfeed, because of the numerous benefits of breast milk for the baby.  However, it is always important to talk with your doctor to weigh the benefits of breastfeeding against the mother’s use of anticonvulsant medication.

Compiled from the following Resources:
Children’s Hospital of Orange County (2014). High-Risk Pregnancy: Neurological Conditions. Retrieved from https://www.choc.org/healthlibrary/topic.cfm?PageID=P02474
Cunningham, Leveno &Bloom (2005). Williams Obstetrics( 22nd ed). New York, NY: McGraw-Hill
Family Doctor Staff (2014, March). Epilepsy and Pregnancy. Retrieved from
Mayo Clinic Staff (2014, July 19). Epilepsy and pregnancy: What you need to know. Retrieved from  https://www.mayoclinic.org/healthy-living/pregnancy-week-by-week/in-depth/pregnancy/art-20048417
NHS(2014, April 24). Epilepsy and Pregnancy. Retrieved from https://www.nhs.uk/conditions/pregnancy-and-baby/pages/epilepsy-pregnant.aspx
Nulman, Laslo & Koren (2012, October 10). Treatment of Epilepsy in Pregnancy.Nulman, Laslo & Koren (2012, October 10). Treatment of Epilepsy in Pregnancy” href=”https://link.springer.com/article/10.2165/00003495-199957040-00006″ target=”_blank”>https://link.springer.com/article/10.2165/00003495-199957040-00006
NYU Langone Compressive Epilepsy Center. Epilepsy in Women.
Reece & Barbieri (2010). Obstetrics and Gynecology: The Essentials of Clinical Care. New York, NY: Thieme