Epilepsy in Pregnancy

Most women who have epilepsy do not have a seizure during pregnancy and have healthy pregnancies and healthy babies.

If you are planning a baby, let your GP or epilepsy specialist know. They will review your medication and discuss with you the best way to prepare for a pregnancy. This will include taking folic acid at the higher dose of 5 mg daily.

Your consultant obstetrician will look after you and your baby during pregnancy. You must not stop or change your epilepsy medication unless so advised by your neurologist. You should be able to have a vaginal birth.

You are at increased risk of having seizures during labour and after birth. Taking your medication regularly and getting enough rest lowers this risk.
Breastfeeding is safe even if you are taking epilepsy medication

Risks to you; Some women with epilepsy may have more seizures when they are pregnant. This is usually because they have stopped taking their medication, or are not taking it regularly. Pregnancy itself or tiredness can also increase the number of seizures. If this happens to you, you should consult your healthcare professional.

There are different types of seizures and your doctor should give you information on the type of epilepsy you have and possible effects on you and your baby. Most types of epilepsy will not cause any harm to you or your baby. Medications for epilepsy should never be discontinued or changed without consulting your healthcare professional.

A very rare but serious complication of poorly controlled epilepsy is sudden unexplained death with epilepsy (SUDEP), which may occur more frequently in pregnancy.

Risks to your baby; With any pregnancy there is a small chance that your baby may not develop normally in the womb. The risk of this happening may be slightly higher with certain epilepsy medications. The risk depends on the type of medication you are taking and the dosage, and it increases if you are taking more than one medication for epilepsy. The most common problems for your baby linked to these medications include spina bifida, facial cleft or heart abnormalities. Taking folic acid reduces this risk.

The epilepsy medication sodium valproate is known to cause harm to developing babies. This includes physical problems and an increased risk of developmental delay, a condition that can affect communication, language skills and behaviour. If you are taking sodium valproate your epilepsy specialist should change this to an alternative medication before you become pregnant. You should speak to them to make a plan for your pregnancy before you stop your contraception. If you become pregnant unexpectedly while taking sodium valproate do not stop the medication yourself but tell your GP and epilepsy specialist straight away so they can discuss the safest options for treatment with you.

All pregnant women are advised to take folic acid as it helps to reduce the risk of their baby having spina bifida. It may also reduce the risk of heart or limb defects. Your doctor will advise you to take a daily dose of 5 mg of folic acid. This is higher than usual and will need to be prescribed for you. This higher dose is needed because of your epilepsy medication, which can increase the risk of your baby being born with spina bifida.

If you are planning to have a baby, it is worth continuing contraception until you have seen a neurologist or epilepsy specialist and have taken folic acid for 3 months. Your GP or family planning service can advise you on which contraception is best for you if you are unsure.

As most of your baby’s development takes place in the first 3 months of pregnancy, you should ideally be taking folic acid for 3 months before you conceive and continue to take it until you reach your 13th week of pregnancy.

The UK Epilepsy and Pregnancy Register. This was set up in 1996 to collect information about the epilepsy medication that women take during pregnancy and the health of their babies. It also gives advice about epilepsy medication(s) taken during pregnancy. You will be invited to join the Register. You can also contact the Register directly on Freephone 0800 3891248.

You will be advised to give birth in a consultant-led maternity unit with a special care baby unit so that you and your baby can get extra care if needed.

The risk of having a seizure during labour is very small, especially if your epilepsy is well controlled. However, being tired, dehydrated and in pain can increase the risk, so make sure that you have as much support, rest and pain relief as possible.

You should bring your epilepsy medication to hospital with you and take it as you normally would during your labour.

Gas and air, TENS machines and an epidural are all suitable for pain relief. Injections of a strong pain reliever such as diamorphine can also be used. Pethidine (another type of pain relief) is not recommended, because in high doses it has been linked with seizures.

You will be offered an injection of vitamin K for your baby. Vitamin K is needed for blood to clot properly. Levels are low in all newborn babies, which puts them at risk of bleeding. Some anti-epileptic medication can further lower vitamin K levels.

You may have more seizures after giving birth because of tiredness, stress and anxiety. Get as much rest and help with your baby as you can. 

Your midwife and epilepsy nurse will talk to you about ways of keeping your baby safe if you have a seizure, including:

• getting plenty of help and rest
• using very shallow baby baths
• nursing your baby on the floor
• laying your baby down if you have a warning aura

How you choose to feed your baby is a very personal decision. There are many benefits of breastfeeding for you and your baby. Epilepsy medication can pass into breastmilk but the amount is usually too small that it is not harmful. Breastfeeding is considered safe even if you are taking epilepsy medication.

Hope you found this information helpful.