Epilepsy and pregnancy

Key points about epilepsy and pregnancy

  • If you are a woman of child-bearing age with epilepsy there are a number of important considerations regarding pregnancy that you need to be aware of.
  • This page discusses the use of anti-epileptic medication during pregnancy and answers some commonly asked questions about epilepsy and pregnancy.
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The odd, single seizure during pregnancy is usually of no harm to a baby but does put the mother at risk of possible injury or accident, which in turn 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.

It is really important that you DO NOT STOP or decrease the dose of your antiepileptic medication during pregnancy without a doctors direction as this can be unsafe for both you and your unborn baby.

Most women (9 out of every 10 women), taking anti-epilepsy medication will have a normal pregnancy and deliver a healthy baby. Anti-epilepsy 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 is a risk that a child may have a malformation (such as spina bifida, cleft lip or palate, or heart defects), learning problems or autism. This risk is higher if you are taking anti-epileptic medication. How much the risk is increased depends on many factors, such as the type of medicine, the dose of medicine, the number of anti-seizure medicines you are taking. The risk seems to be highest for women:

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

If you find out that you are pregnant you should urgently make an appointment to see your doctor. Your doctor will assess whether it is safe to change your medication or decrease the dose. Read more about the risks and benefits of taking anti-epilepsy medicines(external link)(external link).

You should NOT STOP or decrease the dose of your antiepileptic medication without a doctors direction as this can be unsafe for you and your baby. If you are not yet pregnant but are planning to become pregnant, stopping, changing or decreasing your antiepileptic medicine may be an option. Your doctor may suggest a change of medicine before you become pregnant. Experts recommend that this trial take place at least 6 months before the pregnancy so that you and your doctor can see the results.

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

All women who are planning a pregnancy are advised to take folic acid before conception, to reduce the chance of neural tube defects (such as spina bifida) in the baby. 

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, such as:

  • See your doctor at least 6 months before you start trying to have a baby, so that you can talk about the best ways to manage a healthy pregnancy.
  • Take your anti-epilepsy medication exactly as your doctor prescribed. Do not adjust the dose or stop taking the medication without discussing this with your doctor first. Remember, uncontrolled seizures can cause harm to your baby.
  • Make healthy lifestyle choices such as:
    • Eat a healthy diet.
    • Exercise regularly.
    • Take folic acid and prenatal vitamins.
    • Get enough sleep.
    • Avoid 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-epilepsy medication, the medication may not have a chance to work properly. Talk to your doctor for advice on how best to manage your anti-epilepsy medication. A few suggestions may be:

  • Try changing the time of day you take your anti-epilepsy medication, for example, if you find you are sick in the morning, delay your morning dose until after the sickness has passed. But, it is important (as far as possible) to keep the length of time between doses the same.
  • If you vomit within one hour after taking your anti-epilepsy medication, you may need to take a second dose.

Although seizures can be risky, many mothers who have seizures during pregnancy deliver healthy babies. Tell your doctor about the seizure. Your doctor may adjust your medication to help prevent other seizures. 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. Women who have epilepsy use the same methods of pain relief during labour and delivery as other pregnant women.

It is not usual for seizures to occur only during labour. If you do have a seizure during labour, intravenous (injected) medication can be used to stop the seizure. If the seizure goes for a long time, your health care provider might deliver the baby by caesarean delivery.

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. 



(ACC, NZ, 2019)

Brochures

epilepsy medicines and pregnancy

Epilepsy medicines in pregnancy(external link)

Medicines and Healthcare products Regulatory Agency, UK, 2021

valproate

Valproate – patient guide(external link)

Medicines and Healthcare Products Regulatory Agency, UK, 2020

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Professor Lynette Sadleir, Paediatric Neurologist, University of Otago, Wellington

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