Topic Overview

Most women who have epilepsy deliver healthy babies. But the risk of birth defects, stillbirth, and seizure-related problems is higher for babies born to women with epilepsy. Most antiepileptic medicines increase the risk even more.

If you have epilepsy and become pregnant, stopping medicine treatment is not always the best solution. Having seizures during pregnancy can also harm the baby. And pregnancy causes changes in your body that may increase the frequency of seizures.

The following information is based on guidelines from the American Academy of Neurology.^{footnote 1, footnote 2}

Before you become pregnant

Before you become pregnant, talk with your doctor about your epilepsy treatment. Seizures or seizure medicine may cause damage to the baby very early in your pregnancy, before you even know that you are pregnant. Your doctor will help you consider whether potential seizures or continued use of antiepileptic medicine poses the greater risk to your baby.

In general, the recommendation is to only use one medicine for epilepsy and to use it at the lowest possible dose to avoid potential problems from the medicine. Medicines may not harm a baby as much as the pregnant woman having seizures may.

If you are not yet pregnant but are planning to become pregnant, stopping medicine might be an option if you have been seizure-free for several years. Your doctor may suggest a trial run without the medicine before you become pregnant. Experts recommend that this trial run take place at least 6 months before the pregnancy so that you and your doctor can see the results of stopping your treatment. If you begin having seizures, you may need to go back on medicine.

While you are pregnant

If you need to stay on medicine during your pregnancy, your doctor may suggest some changes in your treatment that reduce the risk of birth defects. These changes may include:

• Switching to a medicine that is safer for the baby.
• Taking a single medicine.
• Changing the medicine dosage.
• Having blood tests to make sure you have the right levels of seizure medicine in your body.
• Taking folic acid or other supplements before you conceive and during certain times of your pregnancy. (Folic acid reduces the risk of some birth defects.)

You may put yourself and your baby at greater risk if you change, reduce, or stop taking your medicine while you are pregnant. Talk with your doctor first.

Other concerns

• During your pregnancy, you may need more frequent checkups to monitor the baby’s condition and blood tests to monitor your drug levels.
• After your baby is born, he or she may need to take extra vitamin K for a short period of time. (Some antiepileptic medicines can cause a temporary blood disorder in newborns that makes it difficult for their blood to clot normally. Vitamin K can help reverse this problem.) Your doctor may recommend that you take vitamin K during your pregnancy.
• Breastfeeding while you are taking antiepileptic medicine is usually safe. But talk to your doctor about any concerns you have. If you are taking a barbiturate (such as phenobarbital) to control your seizures, breastfeeding may make the baby drowsy or irritable, because the drug may get into your breast milk.

If you have epilepsy and find out that you are pregnant, consult your doctor immediately. Do not stop taking your medicine without first talking to your doctor.