Share this on:Copied!

In the past, people with epilepsy often heard that getting pregnant was “too risky,” says Page Pennell, MD.

Dr. Pennell is a UPMC neurologist with expertise in pregnancy and epilepsy. She is chief of the Department of Neurology at UPMC.

“A lot of it was out of fear because we didn’t have the information to safely manage women with epilepsy during pregnancy,” she says.

Now, thanks to studies, the answer to the question, “Can a woman with epilepsy have a baby?” is yes.

Doctors know which anti-seizure medications are safe for pregnancy. Studies show that more than 90% of people with epilepsy have normal pregnancies and healthy babies.

Here are the steps you should take before, during, and after pregnancy to protect your health and your baby’s health.

Before Pregnancy

Talk to your doctor about your wishes to grow your family, ideally about a year before you hope to become pregnant. They may want to switch you to an anti-seizure medication that is safer during pregnancy.

Tapering off from taking your current drug and finding the best new medication and dosage for you can take time. Switching medications can make you more prone to a seizure during the adjustment process; that’s why this process should happen before pregnancy.

If you have an unplanned pregnancy, talk to your doctor right away about whether your medication is safe. They can help you make a plan to switch medicines if necessary.

Valproic acid, or valproate, poses the highest risk of causing congenital disabilities in pregnancy. Other medications slightly or modestly increase the risk of problems. Complications related to epilepsy medicines can include congenital disabilities, preterm birth, preeclampsia, and having a baby with a low birth weight.

Thankfully, some anti-seizure medications don’t increase the risk of congenital disabilities and don’t impact pregnancy. When choosing the best medication for you, your doctor will balance the need to control seizures during pregnancy with the need to reduce risks to the fetus. Read more about safely taking anti-seizure medications in pregnancy.

The Epilepsy & Pregnancy Medical Consortium (EPMC) advises pregnant women with epilepsy to start taking prenatal vitamins three months before pregnancy. In particular, it is recommended that women take between 400 and 1000 micrograms of folic acid daily to reduce the risk of congenital abnormalities. If spina bifida runs in your family, talk to your doctor about taking a higher dose of folic acid.

During Pregnancy

Most people with epilepsy don’t have an increase in seizures during pregnancy as long as they get proper epilepsy care.

You should closely track your seizure symptoms and tell your doctor about all seizures, even mild ones. Generalized seizures (affecting the whole brain) pose more risk to the fetus than do focal seizures (affecting part of the brain). But if you get more focal seizures during pregnancy, you’re at a higher risk for a generalized seizure.

A single, brief seizure is unlikely to harm you. However, seizures can lower the fetal heart rate, increase the risk of preterm birth, and reduce oxygen to the fetus. They can also result in injury to the fetus from falling or severe convulsions.

If you have a seizure, let your doctors know. Your care team will monitor your fetus more closely. Your epilepsy doctor may increase your medication dosage.

Your neurologist or obstetrician will also check the levels of anti-seizure medication in your blood every four weeks throughout your pregnancy. Because pregnancy can cause your body to process medication differently, the amount of medication in your blood can drop.

If this happens, your care team will increase your dosage during pregnancy. This way, you’ll continue to have enough medication in your system to prevent a seizure.

You should also continue to take your prenatal vitamins throughout pregnancy.

During Labor and Birth

Epilepsy alone isn’t a reason to need a cesarean section (C-section). Unless you need a C-section for a specific reason (such as the position of the fetus), you can have a vaginal birth.

Many people with epilepsy worry about having a seizure during labor or birth. The chances this will happen are low. Less than 2% of people with epilepsy have a seizure during labor, according to a review in the journal Continuum.

The EPMC advises women at risk of having a seizure during labor and birth to get an epidural. Pain medication lowers stress levels during labor, reducing seizure risk. If you do have a seizure, your care team will have medication to treat your seizure that is safe for your fetus.

Remember to bring your epilepsy medication to the hospital for your labor and delivery stay. You may need to stay at the hospital for two to four days, depending on whether you have a vaginal birth or C-section. Bring your medication in the original bottles so that your care team will know the dosage and timing of your medication.

If you need a C-section or may need one, you may find you can’t take medication by mouth in the hours before the birth. (This is to prevent any stomach contents from coming back up during surgery.) In this case, your care team will provide anti-seizure medication through an IV.

After Pregnancy (The Postpartum Period)

Because sleep and stress reduction are key to preventing seizures, you should limit guests in the postpartum period. You may not wish to have visitors aside from your partner or other support people while you’re at the hospital. If you do have visitors in the hospital, limit how long they stay so you have time to rest.

When you’re home, you’ll want to take extra precautions to get enough sleep and to keep your baby safe in the event of a seizure. Read more about caring for yourself and your newborn.

If doctors increased your medication dosage during pregnancy, they’ll need to lower it in the weeks after pregnancy. The EPMC suggests talking to your doctor before birth about their plan to taper your medications so you know what to expect.

Your doctor may suggest lowering your dose but still keeping it higher than before pregnancy for the first few months after birth. This is because the sleep deprivation of caring for a newborn puts you at a higher risk of having a seizure.

Can I breastfeed my baby if I’m on epilepsy medication?

Yes, breastfeeding is safe for people with epilepsy. Major studies haven’t found any negative impacts for babies exposed to anti-seizure drugs in breast milk. The amount of medication in breast milk is very small.

Instead, breastfeeding is positive for both parents and babies. Through breastfeeding, you pass on antibodies that help your baby fight infection. Breast milk is easier to digest than formula for babies, and breastfeeding can be a great way to bond with your baby.

Some medications to prevent or treat seizures can, in rare cases, make breastfed babies sleepy or cause low iron. Talk to your doctor about precautions you should take if breastfeeding and taking certain anti-seizure medications.

These medications include:

• Ethosuximide
• Diazepam
• Lamotrigine
• Lorazepam
• Phenobarbital
• Primidone

Contact the UPMC Comprehensive Epilepsy Center if you are pregnant or considering becoming pregnant and have epilepsy or another seizure disorder.