Epilepsy and Pregnancy

Epilepsy is common and it affects around 456,000 people in the UK. The main symptoms of epilepsy are repeated seizures.

It is hard to predict how pregnancy will affect epilepsy. For some women their epilepsy is unaffected, others may see an improvement in their condition, while others may find their seizures become more frequent and severe.

Your care during pregnancy

As early in pregnancy as possible, you will be referred to an obstetrician who will discuss and plan your care during pregnancy. A neurologist may also be involved in putting this plan together. We will involve a multidisciplinary team to give you the best care in pregnancy.

Drug treatment

Many women with epilepsy use drugs to keep their seizures under control. However, some of
these drugs increase the risk of physical, brain and learning problems in the developing baby. They can increase the chance of a range of conditions such as spina bifida, heart abnormalities and cleft lip.

For a woman without epilepsy who is not taking medication, the chance of one of these types of problems arising is around one in 50. For a woman who takes drugs to control epilepsy, that risk increases depending on the drug and dose to between around one in 50 (the same as no treatment) to one in 10. This means that most women taking anti-epileptic drugs will have a healthy child.

One medication that is known to cause a significantly higher risk of developmental problems is Sodium Valproate (Epalim, Depacote, Convulex).

This medication is usually only prescribed when essential in women of childbearing age so, if you are taking it is important not to stop it suddenly. If you take this medication it is important
to see your obstetrician and neurologist as soon as possible during pregnancy to look at the risks and benefits of being on this medication compared to changing to another medication.

To minimise the risk to your baby’s development, it is sometimes possible to switch to safer drugs, cut the dose or change the way the drugs are given. This should only be done by a professional who has specialised knowledge in the treatment of epilepsy.

It is usually better to make any changes to drug treatment before rather than during pregnancy. Do not alter drug treatment or stop taking treatment without taking specialist advice, especially during pregnancy. A severe seizure during pregnancy could result in the death of both mother and baby.

If you are taking drugs to control epilepsy it is recommended that you take a high (5mg) daily dose of folic acid as soon as you start trying for a baby. Your GP will need to prescribe the folic acid which may protect your baby against the effects of your anti-epileptic drugs.

If you become pregnant unexpectedly and have not been taking folic acid, start taking it straight away. Folic acid should continue throughout pregnancy for some women taking anti-seizure medication.
If we have not given you additional information regarding epilepsy medications in
pregnancy it can be accessed here.

UK Epilepsy and Pregnancy Register

This register has been established to gather information about the care of women with epilepsy and their babies as well as the frequency of malformations in babies of mothers taking anti-epileptic drugs.

Please help us to continue collecting this information by registering. Text ‘Join’ to 07585 509 789 or call 0800 389 1248.

Safety

Your safety is especially important during pregnancy due to changes to your epilepsy. Continue to follow epilepsy safety advice at home and during your leisure activities particularly when in and around water.

SUDEP

Sudden Unexpected Death in Epilepsy (SUDEP) is a rare but serious event when a person with epilepsy dies suddenly and prematurely and no reason for death is found. It can happen during pregnancy, but knowing your risks can help keep you safe.

Having active seizures can put you at risk of injury and death, and there are certain types of seizure which research has shown increase a person’s risk. SUDEP deaths are often unwitnessed with many of the deaths occurring overnight. There may be obvious signs a seizure has happened, though this isn’t always the case. Try to have someone at home with you overnight.

If you find you are having more seizures, seizures at night or are having problems with your anti-seizure medication you may be at a higher risk and it is important to have an urgent review by your epilepsy team, if you are struggling to get in touch the maternity team will be able to help.

Antenatal care

You will be offered ultrasound scans to help detect any physical or structural problems with your baby. Please inform the sonographer that you are epileptic and which drugs you take.

You may be offered extra blood tests to check the levels of treatment drugs. If there is a strong history of epilepsy in your family or your partner’s family, your care team will talk to you about the possibility of your baby inheriting the condition.

Labour, birth and after

Having epilepsy should not affect the timing or way you can give birth.

There is only a low risk of having a seizure in labour but it is recommended that you give birth in hospital. A water birth is usually not advised. During labour you will be looked after by a midwife, and doctors will be available if you need their help. Before birth your doctor will help you complete an individualized care plan for your birth and care postnatally.

Pack some extra medication in your hospital bag as we may not have a supply in the maternity department. If you are experiencing sickness we can give medication to help.

You can access all forms of pain relief but we would usually recommend women with epilepsy avoid pethidine (other similar drugs are available) and Entonox/gas and air for women known to experience absence seizures.

Because some anti-epileptic drugs reduce the ability of your baby’s blood to clot we recommend your baby has the routine vitamin K injection.

We encourage you to breastfeed your baby. Some of your medication gets into your milk but the benefits of breastfeeding usually outweigh any risks. Your midwife or obstetrician can give you advice based on your circumstances and your preferred method of feeding.

Remember to let the baby doctors and your GP know if you were taking anti-seizure medication in pregnancy so they can ensure baby is developing normally. Most contraception is suitable for women with epilepsy, though some pills are less suitable with some anti-seizure medication. You can discuss your plans with your doctor before you go home.

If you think you will be planning a pregnancy in the future contact your GP to start folic acid and get your seizures under the best possible control.