Epilepsy and pregnancy

The occasional, single seizure during pregnancy doesn’t usually harm the baby but does put the mother at risk of possible injury or accident. This could harm their unborn child.

Recurrent or repeated bilateral tonic and/or clonic seizures during pregnancy can harm the baby. They can result in:

• slower heart rate in the baby
• miscarriage 
• increased risk of bleeding in later pregnancy
• early delivery
• poor growth for the baby.

Recurrent or repeated bilateral tonic and/or clonic seizures are associated with a high risk of death for the mother.

Read more about tonic and clonic seizures.

It’s really important that you DO NOT STOP or decrease the dose of your anti-seizure medication during pregnancy without a doctor or nurse prescriber’s advice as this can be unsafe for you and your unborn baby.

Most women (9 out of every 10) taking anti-seizure medication will have a normal pregnancy and deliver a healthy baby. Anti-seizure medication taken during pregnancy can affect some babies, but it may not harm your baby as much as having seizures during the pregnancy.

In any pregnancy, there's a small risk that a child may have a malformation (eg, spina bifida, cleft lip or palate, or heart defects), learning problems or autism. This risk is higher if you’re taking anti-seizure medication. How much the risk is increased depends on many factors, including the type of medication, the dose of medication, and the number of anti-seizure medications you're taking.

The risk is highest for women:

• taking sodium valproate
• taking more than 1 anti-seizure medication
• taking high doses of anti-seizure medications.

All women with epilepsy should have an early ultrasound and medical assessment. If you find out you’re pregnant you should urgently make an appointment to see your healthcare provider. They'll assess whether it is safe to change your medication or decrease the dose. Read more about the risks and benefits of taking anti-seizure medications(external link).

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You should NOT STOP or decrease the dose of your anti-seizure medication without a doctor’s direction as this can be unsafe for you and your baby.

Stopping epilepsy medication without medical advice is associated with an increased risk of death from seizures.  If you're not currently pregnant but are planning to become pregnant, changing medication, decreasing the dose, or (less likely) stopping your anti-seizure medication may be an option. Your healthcare provider may suggest trying a change of medication before you become pregnant. Experts recommend that this trial takes place at least 6 months before your pregnancy so that you and your healthcare provider can see how it goes.

Folic acid (also known as folate) is a vitamin that's important for the development of the neural tube in an unborn baby. As the baby grows, the neural tube develops into their brain and spinal cord.

All women who are planning a pregnancy are advised to take folic acid before conception (before they get pregnant), to reduce the chance of neural tube defects, eg, spina bifida.

How much should I take?

For women who are taking medication for epilepsy, the recommended dose of folic acid is 5 milligrams once daily. This is a higher dose than for women without epilepsy. Start taking folic acid when you start planning your pregnancy and continue throughout your pregnancy.  

If you have epilepsy and are thinking about having a baby, there are some things you can do to prepare:

• See your doctor at least 6 months before you start trying to have a baby, so you can talk about the best ways to manage a healthy pregnancy.
• Take your anti-seizure medication exactly as it’s been prescribed. Do not adjust the dose or stop taking your medication without discussing this with your healthcare provider first. Remember, uncontrolled seizures can cause harm to you and your baby.
• Make healthy lifestyle choices, including:
  • eating a healthy diet
  • exercising regularly
  • taking folic acid and prenatal vitamins
  • getting enough sleep
  • avoiding smoking, alcohol and illicit drugs.

During early pregnancy, usually the first 12 weeks, nausea and vomiting are common symptoms (called morning sickness). This can happen at any time of the day and can last longer than 12 weeks.

If you vomit after taking your anti-seizure medication, it may not have a chance to work properly. Talk to your healthcare provider about how best to manage your anti-seizure medication. A few suggestions may be:

• Try changing the time of day you take your anti-seizure medicine, eg, if you find you're sick in the morning, delay your morning dose until after the sickness has passed. But it's important (as far as possible) to keep the length of time between doses the same.
• If you vomit in the first hour after taking your anti-seizure medication, you may need to take a second dose.

Although seizures can be risky, many women who have seizures during pregnancy deliver healthy babies. Tell your healthcare provider about the seizure.

Close monitoring of your epilepsy and medicine should be done throughout your pregnancy by your healthcare provider or specialist. Most anti-seizure medication doses need to be adjusted and increased during pregnancy to keep you seizure free, especially lamotrigine. The higher doses don't add any significant risk to your baby. Regular blood tests are recommended during your pregnancy to help with adjusting the dose of your medications. The doses can be reduced after delivery.

If you have a seizure in the last few months of your pregnancy, your healthcare provider might monitor your baby at the hospital or clinic.

Most pregnant women who have epilepsy deliver their babies without complications. You can use the same methods of pain relief during labour and delivery as other pregnant women.

It’s not usual for seizures to occur only during labour. If you do have a seizure during labour, intravenous (injected) medicine can be used to stop the seizure. If the seizure goes for a long time, your healthcare provider might deliver the baby by caesarean delivery (C-section).

If you have frequent seizures during your third trimester, your healthcare provider might recommend an elective caesarean delivery to avoid the risk of a seizure during labour.

It's considered safe to breast feed your baby while taking medication for epilepsy. The baby will be exposed to small amounts of the medicine, but has been exposed to higher amounts during the pregnancy. The medical staff will monitor your baby after birth to ensure there are no problems for your baby.

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