Women with epilepsy may wonder what their chances are of having a healthy baby

Jul 23 2004

Women with epilepsy may wonder what their chances are of having a healthy baby. They can relax with the knowledge that their chances of having a normal, healthy child are greater than 90 percent.

There are, however, some increased risks for women with epilepsy that they should consider before getting pregnant, if possible. Both the neurologist and the gynecologist/obstetrician need to be involved in reviewing medication and any potential changes prior to the beginning of a pregnancy.

What should a woman with epilepsy do to get ready for a pregnancy? She should be in good general health and pay attention to nutrition before and during pregnancy. A regular schedule with adequate exercise and appropriate rest will keep a pregnant woman physically fit and may help manage stress. It is important to take vitamins with folic acid prior to and throughout pregnancy, to reduce the risk of certain kinds of birth defects. Since many of these problems occur very early in pregnancy, it is wise to start taking folic acid before becoming pregnant.

How can pregnancy affect seizures? Most women will see no change in their seizures. One quarter to one third of women with epilepsy who become pregnant will have increased seizures during their pregnancy despite continued use of anti-epileptic medication. During pregnancy, concentrations of seizure medication in the bloodstream may change or decrease, putting a woman at greater risk for seizures. The physician may need to check blood levels of medication more often, and may need to adjust the dose.

Women may wonder if it’s true that medication taken for seizures may affect their children. Yes, there may be some increased risk to children of women with epilepsy who are taking seizure medications. In the general population there is a 2 to 3 percent chance that a child will have a birth defect (also called a congenital malformation). In women with epilepsy, this risk is increased to 4 to 8 percent. In general, there seems to be higher risk if a woman is taking more than one seizure medication, particularly at high doses.

But there are other risks, to both mother and developing child, from uncontrolled seizures. Most women with epilepsy should continue their seizure medication, and whenever possible, take a single anti-epileptic drug at the lowest dose that provides seizure control. It is important to work with the health care team to make the best decisions about medications during pregnancy. Remember, women should never stop taking their antiepileptic drugs or change the doses without the advice and the supervision of the doctor.

Other problems to consider are that women with epilepsy are more likely to have morning sickness and vaginal bleeding during pregnancy. There is an increased risk for early labor and delivery. Sometimes labor does not progress normally and more women with epilepsy need to have cesarean sections to deliver their babies than other women. There is a small risk that the baby will develop a bleeding problem in the first 24 hours after birth. Women with epilepsy are often given oral vitamin K supplements during the last month of pregnancy to lessen the chances of this happening to their babies.

In summary, just like any other pregnancy, good pre-natal care and good communication with the medical team can increase the chances of a happy, healthy blessed arrival.

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