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If you have well-controlled epilepsy, your seizures likely won’t increase during pregnancy. But doctors may need to change your dose of anti-seizure medication to ensure you remain seizure-free.

Here’s what you can expect with seizure stability with epilepsy during pregnancy and how you should respond if you have a seizure while pregnant.

Can Pregnancy Make Epilepsy Worse?

Previous research showed that some people with epilepsy (about 35%) had more seizures during pregnancy. But a more recent study from the New England Journal of Medicine found pregnant women with epilepsy didn’t have more seizures than nonpregnant women with epilepsy. This may be because doctors are now better at managing epilepsy in pregnancy. This could explain this difference between older and newer studies.

The research also showed that if you don’t have seizures in the nine months before pregnancy, you’ll likely stay seizure-free during pregnancy.

Though pregnancy doesn’t usually make epilepsy worse, it can change how your body absorbs anti-seizure medication. If medication moves out of your system more quickly in pregnancy, your doctor may need to up your dosage.

During pregnancy, your neurologist or obstetrician (ob-gyn) will measure the level of anti-seizure medication in your blood every four weeks. If the level drops too low, your epilepsy doctor will increase your dosage.

On the higher dose, your body will still absorb a similar amount of the medication as it did before pregnancy. So you shouldn’t notice an increase in side effects.

The NEJM study found that 70% of women needed a higher dose of anti-seizure medication during pregnancy. In comparison, 24% of nonpregnant women with epilepsy in a control group needed to increase their dosage over the same nine-month period.

How Can I Avoid Seizures During Pregnancy?

For your safety and your baby’s safety, you should take anti-seizure medication as directed throughout your pregnancy. If you miss a dose, take your medicine as soon as you realize it.

Experts advise people with epilepsy to find an ob-gyn to provide pregnancy care. Family doctors and midwives care for people with lower-risk pregnancies and, therefore, aren’t ideal for people with complications like epilepsy. Make sure you go to all of your scheduled prenatal visits and reschedule appointments if you miss them.

If you vomit often in pregnancy, you could lose some of your medication. Your doctor can help you make diet changes and may also suggest you take your medication at a different time to lower this risk. Your ob-gyn can also prescribe medication to prevent morning sickness.

It’s especially important to track seizure activity in pregnancy, including symptoms you have before, during, and after a seizure. Doctors may need to adjust your medication if you experience more seizures while pregnant. Check out the Epilepsy Foundation’s website for tips and resources that can help you track your seizure triggers and symptoms.

Finally, because sleep is a seizure trigger, take steps to ensure you get enough sleep. Body pillows can help you find a comfortable position when you’re pregnant. You may feel extra tired in the first trimester, so you may need to nap and go to bed earlier.

Insomnia, frequent urination, and aches and pains in the third trimester may wreak havoc on your sleep as well. You might consider taking time off work if you’re not getting enough rest to stay seizure-free.

Are Anti-Seizure Medications Safe for Pregnancy?

Not all anti-seizure medications are safe for pregnancy. Some increase the risk of congenital disabilities.

You should talk to your doctor before getting pregnant to see if you should switch your anti-seizure medication. In case of an unplanned pregnancy, talk to your doctor as soon as possible. See our list of which epilepsy drugs are safe for pregnancy and which ones carry risks to the fetus.

Your epilepsy doctor will give you and your family instructions on how to respond to a seizure if you do have one. You can treat a seizure in pregnancy the same way you would treat a seizure if you weren’t pregnant. If your symptoms are severe, your care provider should call 911.

You may need rescue medications to treat a seizure, such as lorazepam, diazepam, or midazolam. You can use these in pregnancy, says Dr. Page B. Pennell, UPMC neurologist and chief of the UPMC Department of Neurology. “These are used very infrequently and only if necessary, in such low doses that we don’t need to worry about harm due to exposure to the developing baby,” she explains.

You should let both your ob-gyn and your epilepsy care provider know right away if you have a seizure. Some complications of pregnancy — like blood clots or eclampsia — can cause seizures. Your ob-gyn will want to make sure your seizure isn’t pregnancy-related.

If your seizure isn’t pregnancy-related, your epilepsy doctor may need to increase your seizure medication. They may do this even if your last test showed the medication levels in your blood were in the target range.

Even if you have very mild seizure symptoms, let your doctor know. An increase in mild seizures can mean you’re at a higher risk for tonic-clonic (generalized) seizures. These can be dangerous for you and your baby during pregnancy.

How Does Having a Seizure Affect a Fetus?

How seizures affect fetuses is hard to know, but brief seizures in pregnancy are unlikely to harm a fetus, especially if they’re uncommon.

Doctors don’t think that focal seizures, whether or not they reduce awareness, affect fetuses in a lasting way. However, a focal seizure could temporarily slow the fetal heart rate.

A generalized seizure, especially if it lasts a long time, can reduce the fetus’ oxygen supply. It could also cause injury, either from a fall or due to jerking movements during a seizure. However, the womb’s cushioning is very protective of the fetus.

A generalized seizure may increase the risk of preterm birth. One study in JAMA Neurology found that women who had seizures had about a 60% higher risk of having a preterm birth than those who didn’t have seizures. They had a 35% increased risk of having a low birthweight baby.