Getting Pregnant with Epilepsy: What to Know | UPMC HealthBeat (2024)

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Decades ago, doctors would advise women with epilepsy not to get pregnant. That’s because doctors thought pregnancy would increase seizures. Now if you ask: Can someone with epilepsy get pregnant? The answer is yes.

People with epilepsy can get pregnant, stay healthy and seizure-free throughout pregnancy, and give birth to a healthy baby.

But if you have epilepsy and plan on getting pregnant, you should talk to your doctor. Depending on your health history and current medications, your ob-gyn may consider your pregnancy “high-risk.” You may need to change your anti-seizure medication many months before getting pregnant, if possible.

Can a Woman with Epilepsy Get Pregnant?

Yes, both women and men with epilepsy can have children. While epilepsy itself isn’t known to affect fertility, some medications that treat epilepsy can lower fertility.

Valproic acid may bring about a higher risk of polycystic ovarian syndrome (PCOS), and this can lower fertility in women. Valproic acid also seems to slightly weaken male fertility. Phenytoin, carbamazepine, and phenobarbital may affect fertility, but there isn’t enough evidence to say for sure.

Newer medications for treating epilepsy don’t seem to affect fertility. Historical studies found people with epilepsy were slightly less likely to have children, according to a review published in Current Opinion in Neurology. More recent research shows no difference in fertility rates among people with and without epilepsy.

If you do need fertility treatments, talk to your epilepsy doctor first. Certain hormone-based fertility treatments could reduce how well some anti-seizure medications work. Your doctor may suggest changing your anti-seizure medication before you pursue certain fertility treatments.

Getting Pregnant with Epilepsy: What You Need to Know

If you have epilepsy but want to get pregnant, you should plan your pregnancy well in advance. The Epilepsy & Pregnancy Medical Consortium (EPMC) recommends you talk to your neurologist one year before becoming pregnant.

If you have an unplanned pregnancy, let your doctor know right away. That’s because you may need to switch to anti-seizure treatment that is safer for pregnancy.

Certain epilepsy medications can slightly increase the risk of congenital disorders. The rate of congenital disorders in babies born to women taking anti-seizure medication is 4% to 6%. That’s slightly higher than the 2% to 3% rate of congenital disorders among the general population.

The actual risk depends on the medication and the dosage. If you’re on a medication that could increase the risk of congenital disorders, your doctor may suggest switching your medication ahead of pregnancy. You can switch epilepsy medications during pregnancy, though it’s better for you and your fetus if switches happen before pregnancy.

They may also suggest you reduce the different types of anti-seizure medication you take. That’s because taking multiple types of epilepsy medication may add to the risks.

Switching medications before pregnancy can take up to 12 months. Your doctor may start you on a new drug and gradually reduce the dose of one or more of your current medications.

Your doctor will need to follow up with you often to make sure the new medication controls your seizures and doesn’t cause problematic side effects. They may need to increase or lower the dose of your new medicines based on how you respond.

Before pregnancy, you should also supplement with 400 to 1000 micrograms of folic acid daily. The American College of Obstetricians and Gynecologists advises that all women take folic acid throughout pregnancy. Folic acid reduces the risk of having a baby with a brain or spinal cord problem.

Will I Have a High-Risk Pregnancy if I Have Epilepsy?

Most people with epilepsy have healthy pregnancies and healthy babies. Your ob-gyn may recommend you see a maternal fetal medicine (MFM) doctor for additional monitoring during your pregnancy. They base this on your medication use and health history.

People with epilepsy also have a slightly higher risk of some health problems in pregnancy.

Potential complications include:

• Having a baby with a low birth weight.
• High blood pressure in pregnancy (preeclampsia).
• Miscarriage.
• Preterm birth.

More than 90% of pregnant people with epilepsy don’t have any problems. That’s according to a paper published in 2022 in the medical journal Continuum.

Will Seizures During Pregnancy Affect My Baby?

For most women with epilepsy, pregnancy doesn’t cause more seizures. If you don’t have seizures in the nine months before pregnancy, you’re more than 80% likely to stay seizure-free in pregnancy.

An occasional seizure in pregnancy is unlikely to cause any harm. Still, you should work with your doctor to reduce your risk of seizures as much as possible before you become pregnant.

Focal seizures, which affect one part of the brain, may temporarily slow down the fetal heart rate. But doctors think focal seizures are unlikely to have a lasting effect on a fetus.

Generalized (tonic-clonic) seizures, which affect the whole brain, can pose health risks to the fetus. Most women who have one or more generalized seizures in pregnancy still give birth to healthy babies. But, this type of seizure can increase the risk of low oxygen to the fetus, preterm birth, and injury (due to a fall or jerking movements).

They can also cause a pregnant person to fall. A serious fall could injure a fetus.

If you have a seizure during pregnancy, you should let your ob-gyn and neurologist know. They can more closely monitor the fetal heart rate, fetal growth, and other signs of fetal health. They may recommend changes to your epilepsy medicine.

Will I Pass Epilepsy to My Baby?

Epilepsy is rarely passed down from parent to child. If you or the child’s father has epilepsy, your child has a 3.5% to 6% chance of developing epilepsy, the EPMC states. That compares to the 1% to 2% risk of epilepsy that all children face. Be sure to talk to your epilepsy doctor for additional information on genetic risks for epilepsy.

Contact the UPMC Comprehensive Epilepsy Center if you are pregnant or considering becoming pregnant and have epilepsy or another seizure disorder.