What To Do if You Have Epilepsy and Want To Have a Baby

While it’s true that epilepsy raises reproductive hurdles for women, they are not insurmountable, thanks to newer anti-seizure medications at well-managed dosages. With a little planning and close medical monitoring, women with epilepsy have every reason to expect successful pregnancies ending with healthy babies.

Each year, 20,000 babies are born in the U.S. to women with epilepsy. So clearly, epilepsy will not keep you from getting pregnant. In fact, the likelihood of becoming pregnant is exactly the same for women with and without epilepsy. And certain anti-seizure drugs can interfere with contraceptives designed to block ovulation – potentially leading to unplanned pregnancies. That’s why your doctor will recommend you and your partner use two kinds of contraception while you make sure your body is ready for a successful pregnancy.

Get Your Body Ready

When you decide to start a family, you likely will wonder if your baby could inherit your epilepsy. If your epilepsy has a genetic component (not all do), the answer is yes, but even then, the risk is low. That’s because in most cases the baby must inherit several abnormal genes, each raising the risk of seizures by a small amount. Genetic counseling for you and your partner will help determine your exact risk – knowing, of course, that in most cases epilepsy is a well-managed disease.

So, if you want to have a baby, your diagnosis shouldn’t stop you. But it does mean you need to get your body ready for the upcoming nine-month journey. Specifically, you must:

• Work with your epileptologist/neurologist to get your seizures under control
• Switch to a pregnancy-friendly anti-seizure drug if yours is not
• Let your doctors know you’re planning to become pregnant
• Begin taking folic acid to reduce the risk of birth defects

Before Pregnancy

The most important thing you can do to ensure a healthy pregnancy is to get on the right medicine at the right dosage to control your seizures, because seizures are dangerous both for you and your unborn baby. Any seizure presents a risk of a damaging fall or burn, and a grand mal (tonic-clonic) seizure could cut off fetal oxygen or even induce premature labor or a miscarriage.

Controlling your seizures means finding an effective medicine at an effective dosage. Some older anti-seizure medications – including valproic acid and phenytoin – have been associated with higher risks of birth defects, but with more than 40 drugs for epilepsy now on the market, doctors can find an effective, pregnancy-friendly alternative for every woman of reproductive age.

You should work with your doctor to find the best medicine for you and to determine your baseline – that’s the optimal dose that effectively controls your seizures at your current weight before pregnancy.

Your baseline anti-seizure medication level is important because you will gain weight throughout pregnancy, and your doctor will need to adjust your dosage to keep the medicine at therapeutic levels. You should expect to see your neurologist/epileptologist at least once a month during pregnancy for that important monitoring.

Once your seizures are under control, let your doctors know you’re planning to become pregnant and begin taking folic acid, which promotes cellular growth and maturation of red blood cells. Folic acid is required for the development of your baby’s brain and spinal cord whether you have epilepsy or not. You need this supplement because some anti-seizure medications reduce blood levels of folic acid, and that deficiency could increase the risk of serious birth defects.

During Pregnancy

Everyone’s body responds differently to pregnancy, but most women with epilepsy will see no change or even a decline in their seizure frequency during pregnancy. However 15% to 30% will experience more seizures, especially in the first and third trimesters.

You can help reduce seizures by making sure you get enough sleep and by working with your doctor to keep your anti-seizure medications at therapeutic levels in your changing body.

Labor and Delivery

Most women with epilepsy have normal deliveries with healthy babies, but for 2% to 4%, the stress of labor can trigger a seizure, and that risk can last up to 24 hours after delivery. Because of this, most pregnant women with epilepsy should deliver at hospitals to ensure quick access, if needed, to drugs and procedures to protect both the mother and baby.

Breastfeeding

Breast milk provides important benefits to newborns, and there is no reason not to breastfeed while taking anti-seizure drugs. In fact, one study found breastfed children whose mothers took anti-seizure drugs showed higher IQ and enhanced verbal abilities at age 6.