Your patients: Pregnancy and epilepsy

What are the risks during pregnancy for a patient with epilepsy?

Patients who have epilepsy and are thinking of getting pregnant may have questions about how epilepsy affects pregnancy or a fetus. Epilepsy affects each person differently, based on medication, hormones and other factors. Here are some things to know if your patient has epilepsy and wants to have a baby.

Epilepsy is an umbrella term for a group of seizure disorders. A brain condition, epilepsy is sometimes the result of a brain injury or a family predisposition, but often there is no known cause.

Is it safe for someone with epilepsy to get pregnant?

Most patients with epilepsy will have healthy babies. However, there are several factors that may make it more difficult to conceive, including:

  • People with epilepsy have higher rates of some conditions that can cause infertility, including polycystic ovary syndrome (PCOS).
  • Those with epilepsy are more likely to have irregular menstrual cycles or cycles where no egg is released (anovulation), which can make it more difficult to get pregnant.
  • Anti-seizure medicine and other drugs may affect the hormone levels in the ovaries, which can affect reproductive functioning.
  • Patients with epilepsy are more likely to have abnormalities in hormones involved in pregnancy.

What are some things I can do for patients trying to get pregnant?

Talk with the patient about the medications they are taking for epilepsy. Some drugs used to treat seizures may contribute to infertility, but some may reduce the effectiveness of hormonal birth control methods such as the pill.

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What are the risks?

Any medication taken during pregnancy can affect the baby. Anti-seizure medication has been linked to birth defects, including cleft palate, neural tube defects, skeletal abnormality and congenital heart defects. Some studies suggest that the risk increases with higher doses of medication or when taking multiple anti-seizure medications.

Seizures during pregnancy can result in:

  • Slowing of fetal heart rate
  • Decreased oxygen to the fetus
  • Fetal injury, including separation of the placenta from the uterus, or miscarriage from trauma (such as a fall during a seizure)
  • Preterm labor
  • Premature birth

Talk to the patient about changing medications if they would like to become pregnant. Try to do it at least a year in advance so the patient’s body has time to adjust and see if the new medicine is working well.

Epilepsy during labor and delivery

The most important thing is for the patient and their medical team to work closely before and during pregnancy so potential risks can be minimized to the health of parent and baby.

It is possible for the patient to have a seizure during labor and delivery. Since it is a possibility, the medical team should be aware of the condition and can administer IV anti-seizure medication. Or the patient may have a planned cesarean section (C-section).

The vast majority of patients with epilepsy have uneventful pregnancies and healthy babies.

Offering the highest level of epilepsy care

Norton Neuroscience Institute has been recognized by the National Association of Epilepsy Centers as a Level 4 Epilepsy Center. The designation indicates the ability to provide the highest level of medical and surgical evaluation and treatment for patients with complex epilepsy.

“Together our team of neurologists can create a tailored plan for a patient who is considering becoming pregnant. We work with each patient to evaluate a comprehensive array of treatment options to meet their goals and health care needs as they change throughout their lifetime,” says Ambica M. Tumkur, M.D., neurologist and epilepsy specialist with Norton Neuroscience Institute. “There are a lot of factors to consider when planning a pregnancy, and for patients with epilepsy we want to make sure we have the best plan in place.”

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