Epilepsy is a chronic seizure condition that can affect a person’s pregnancy and postpartum recovery. It does not appear to affect fertility or the ability to become pregnant.
Epilepsy is one of the most common medical conditions among people of reproductive age. It’s estimated that more than 1.1 million women with epilepsy in the United States are of childbearing age. Each year about 24,000 babies are born to people with epilepsy.
This article discusses how epilepsy affects fertility, gestation, and postpartum recovery.
Epilepsy and Fertility
Epilepsy does not impact your ability to become pregnant, but it is best to talk with your healthcare team before pregnancy begins. This is because epilepsy can significantly affect your pregnancy and the baby’s health. Work with your healthcare team to get your seizures well under control before conceiving. People who have been seizure free for nine months before pregnancy are likely to remain seizure-free during pregnancy.
Some epilepsy treatments are not safe during pregnancy. Certain epilepsy medications, known as antiepileptics, have been linked to congenital disabilities when taken during pregnancy. Your healthcare providers may recommend switching medications when you are trying to conceive.
Before getting pregnant, talk with your obstetrician-gynecologist (ob-gyn) and neurologist. Your neurologist will likely recommend a blood test to determine how much epilepsy medication is in your blood. This lab value will act as your baseline throughout pregnancy. Your healthcare providers will monitor your blood to ensure your medication dosage is safe for you and your baby.
Is Epilepsy Genetic?
Epilepsy sometimes runs in families, but most children do not inherit it from their parents. A child has about a 5% increased risk of developing epilepsy if their parent has it.
Epilepsy and Gestation
It is possible to have a healthy pregnancy and baby when you have epilepsy. For the majority of people with epilepsy, their seizure frequency remains the same or even decreases during pregnancy. However, people with epilepsy require special care during pregnancy to ensure their health and safety.
Risks
People with epilepsy are at risk of certain complications during pregnancy. It is possible to experience more seizures when you are pregnant. About 15% to 30% of people with epilepsy experience increased seizure activity during their pregnancies. This increase usually occurs in the first or third trimester.
Possible triggers of increased seizure activity during pregnancy include:
- Hormonal changes
- Water and sodium retention
- Decreased blood levels of antiepileptic medication
- Stress
- Lack of sleep
It is possible to experience more seizures during pregnancy because of how the body metabolizes epilepsy medication. The physical changes during pregnancy, such as weight gain and fluid retention, may cause your blood level of medication to go down.
This means that your body will require an increased dose to prevent seizures. It’s important to see your neurologist regularly and have your blood tested for medication levels. Your neurologist will also test your kidney and liver function regularly.
Pregnant people have an increased level of estrogen. Estrogen is considered pro-convulsive and can increase the risk of seizures.
Treatment
People with epilepsy must follow their treatment plan during pregnancy. Having a seizure while pregnant puts you and your baby at risk of injury and preterm birth. Work with your healthcare team to develop a medication plan to control seizure activity.
Certain antiepileptic medications are unsafe during pregnancy because they raise the risk of congenital disabilities. The risk of congenital disabilities in the general public is 2% to 3%, and the risk in people with epilepsy is 4% to 6%.
The most common congenital disabilities are cleft lip or cleft palate. Both of these conditions can be corrected surgically. Other possible congenital disabilities include cardiac and urogenital defects.
Antiepileptics that have been linked to congenital disabilities include:
- Valproate or Depakote (valproic acid): Increases the risk of neural tube defects by 1% to 2% and increases the risk of major congenital malformations by 10%
- Topamax (topiramate): Increases cleft lip or palate risk
- Phenobarbital: Increases the risk of a fetal bleeding disorder
- Dilantin (phenytoin): Increases the risk of a fetal bleeding disorder
If you are experiencing severe nausea and vomiting during pregnancy, your body may not absorb your medication. Talk with your healthcare provider about possible treatment options for morning sickness.
Concerning Symptoms
Concerning symptoms during pregnancy include increased seizure activity and any complications a seizure can cause. Possible risks of experiencing a seizure during pregnancy include:
- Physical injury (from falling)
- Fluctuating fetal heart rate
- Decreased oxygen to the fetus
- Preterm birth
- Low birth weight
Epilepsy and Postpartum
For most new parents with epilepsy, their condition does not affect their ability to heal in the postpartum period (after the baby is born). It is important to take extra safety precautions when with your baby in case you have a seizure. Perform diaper changes on the floor, and be sure to have another adult present when bathing your child.
Impact on Recovery
Research shows that people with epilepsy may be at increased risk of experiencing anxiety and depression during and after pregnancy. This could have a significant impact on your recovery and quality of life. If you have any concerns about your mood, talk with your healthcare provider immediately. There are treatments available to help you feel more like yourself.
Breastfeeding
Most people with epilepsy can safely breastfeed. If you are concerned about having a seizure while feeding your baby, make a plan with your partner or other supportive people. Consider having another adult present when you breastfeed if your seizures are not controlled.
Many antiepileptic medications can be passed to your baby through your breast milk. Talk with your child’s healthcare provider about which drugs are safe. Medications that may not be safe to take while breastfeeding include:
- Luminal (phenobarbital)
- Mysoline (primidone)
- Ativan (lorazepam)
- Zarontin (ethosuximide)
Summary
Epilepsy is a chronic seizure condition that may affect pregnancy and postpartum. Having epilepsy does not affect your ability to become pregnant, but uncontrolled seizures during pregnancy can cause serious complications to you and your baby.
Talk with your healthcare provider about a treatment plan before, during, and after pregnancy. Certain antiepileptic medications raise the risk of congenital disabilities, so it is important to work with your healthcare team before you become pregnant.
Source: verywellhealth.com, Carrie Madormo RN MPH, Brigid Dwyer
