Pregnancy can bring additional concerns for women living with epilepsy, particularly regarding the safety of anti-seizure medications and the health of their baby. However, many women with epilepsy can have healthy pregnancies with proper planning, appropriate medication and regular medical monitoring.
One of the most important things to remember is that stopping epilepsy medication suddenly after a positive pregnancy test can be dangerous for both the mother and the baby.
In this article, Dr. Asmita Gholap, Consultant Obstetrician and Gynecologist at Momstory, explains how epilepsy can affect pregnancy, why medication management is important, and what precautions women should take before pregnancy, during labour and after delivery.
What Is Epilepsy in Pregnancy?
Epilepsy is a neurological condition that causes a tendency to experience recurrent seizures. Women with epilepsy may already be taking anti-seizure medications when planning a pregnancy or when they discover that they are pregnant.
Their primary concern is often whether these medications could affect the baby’s development.
Although some anti-seizure medications carry a higher risk of birth defects than others, not all epilepsy medications are harmful during pregnancy. The choice of medication, dosage and seizure control should be reviewed by a neurologist and obstetrician.
Can Epilepsy Medication Affect the Baby?
Certain anti-seizure medications may increase the risk of congenital abnormalities, including:
- Neural tube defects
- Certain heart abnormalities
- Cleft lip or cleft palate
The risk depends on the specific medication, dosage and other individual factors.
Some medications, such as valproate, are associated with a higher risk of certain birth defects and developmental problems. Other medications, including lamotrigine and levetiracetam, are often preferred during pregnancy when clinically appropriate.
However, no medication should be started, stopped or changed without medical supervision. The safest treatment plan depends on the type of epilepsy, seizure history and individual circumstances.
What Should You Do If You Are Planning a Pregnancy?
If you have epilepsy and are planning to conceive, it is best to consult your neurologist and obstetrician before trying to become pregnant.
Pre-pregnancy planning may include:
- Reviewing your current anti-seizure medication
- Considering a switch to a medication with a lower risk during pregnancy, if appropriate
- Reviewing the dosage needed to maintain seizure control
- Discussing folic acid supplementation
- Planning the monitoring required during pregnancy
Your doctor may recommend high-dose folic acid, often 5 mg daily, before conception and during early pregnancy, depending on your clinical circumstances. Follow your treating doctor’s advice regarding the dose and duration.
Planning ahead gives your healthcare team an opportunity to balance seizure control with the baby’s safety.
What If You Discover You Are Pregnant While Taking Epilepsy Medication?
If your pregnancy test is positive while you are taking anti-seizure medication, do not stop your medication suddenly.
Sudden withdrawal can trigger seizures, which may cause serious complications for both mother and baby. In some cases, prolonged seizures can become life-threatening.
Instead, contact your neurologist and obstetrician promptly. They can review your medication and determine whether any changes are necessary.
Maintaining seizure control throughout pregnancy is essential.
Is Pregnancy Safe for Women With Epilepsy?
Many women with epilepsy have healthy pregnancies, particularly when seizures are well controlled and medication is appropriately managed.
Women who have been seizure-free for several years may have a different risk profile from those who continue to experience seizures or require ongoing medication.
However, being seizure-free does not automatically mean that it is safe to stop medication. Decisions about treatment should be made with a neurologist based on the individual’s history.
What Precautions Should You Take During Labour?
Labour and delivery require careful planning for women with epilepsy. Pain, stress, dehydration, lack of sleep and missed medication doses may increase the risk of seizures.
Important precautions include:
1. Do Not Miss Your Medication
Continue taking your anti-seizure medication as directed by your healthcare team, including during labour.
If you cannot take oral medication because of vomiting or another medical issue, your team can arrange an appropriate alternative when necessary.
2. Maintain Adequate Hydration
Drink fluids as permitted by your maternity team. Appropriate hydration is important during labour, particularly when there is a risk of dehydration.
3. Manage Pain and Stress
Your obstetrician and anaesthesia team can discuss suitable pain-relief options, including an epidural where appropriate.
4. Get Adequate Rest
Sleep deprivation can trigger seizures in some people with epilepsy. Your healthcare team should be aware of your seizure history so that appropriate precautions can be taken.
Why Is the Period After Delivery Important?
The risk of seizures may remain a concern after childbirth, particularly during the early postpartum period when mothers may experience disrupted sleep, fatigue and changes in medication requirements.
The first few days after delivery are especially important for maintaining hydration, taking medication on time and getting support with newborn care.
Your doctor may also need to review medication doses after delivery because the way the body processes certain anti-seizure medicines can change during pregnancy and postpartum.
How Can You Safely Care for Your Baby If You Have Epilepsy?
Women with epilepsy can care for and bond with their babies. However, a few practical precautions can reduce the risk of accidental injury if a seizure occurs.
Consider the following measures:
- Feeding: Feed your baby while seated in a stable position, preferably with support nearby if you have a risk of seizures.
- Bathing: Avoid bathing your baby alone in a deep tub or basin. Ask another adult to assist.
- Carrying: Avoid carrying your baby while standing or walking if you feel a seizure may be approaching.
- Driving: Do not drive if your seizures are not adequately controlled or if you have been advised not to drive.
- Support: Arrange help from a partner or family member, especially during periods of sleep deprivation.
- These precautions are intended to support safety, not to discourage mothers with epilepsy from caring for their children.
Can You Breastfeed While Taking Epilepsy Medication?
Many anti-seizure medications are compatible with breastfeeding, but the decision depends on the specific medicine, dosage and baby’s health.
Some medications pass into breast milk in small amounts. Your doctor can assess the available safety information and advise whether any additional monitoring is needed.
Do not stop your medication or avoid breastfeeding solely out of fear without discussing your options with your healthcare team.
If you notice unusual sleepiness, poor feeding or other concerning changes in your baby, seek medical advice.
What Additional Monitoring May Be Needed During Pregnancy?
Women with epilepsy may require closer antenatal follow-up depending on their medication, seizure history and other risk factors.
Your healthcare team may recommend:
- Regular obstetric appointments
- Monitoring of anti-seizure medication levels when appropriate
- Detailed fetal ultrasound examinations
- Additional scans or assessments based on individual risk
- A delivery and postpartum seizure-management plan
- The aim is to maintain maternal seizure control while monitoring the baby’s growth and development.
Conclusion
Epilepsy does not automatically prevent a woman from having a healthy pregnancy. With pre-pregnancy counselling, appropriate medication, folic acid supplementation when recommended and regular monitoring, many women with epilepsy can safely navigate pregnancy and childbirth.
The most important precautions are to never stop anti-seizure medication suddenly, consult your neurologist and obstetrician early, take medication consistently and plan for labour and postpartum care.
If you have epilepsy and are planning a pregnancy or are already pregnant, consult your healthcare team to develop a treatment plan tailored to your needs.
For further guidance on pregnancy care, you can consult the team at Momstory Hospital.
