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Is Pregnancy Safe for Women with Epilepsy? 7 Myths About Epilepsy and Pregnancy

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Motherhood can be the most exciting time in your life, but it can also be stressful — especially if you have epilepsy.As a woman with epilepsy, you may have heard a number of rumors about pregnancy and epilepsy.

Well, it’s time for the truth: Even though epilepsy can make pregnancy a bit more complicated, most women with epilepsy have safe pregnancies and healthy babies.

Here are some common myths and facts about epilepsy and pregnancy.

1. Myth: I don’t need to take any extra steps or precautions due to my epilepsy before I get pregnant — just while I’m pregnant.

Fact: If you have epilepsy and want to get pregnant, it’s important to start your journey with a plan.

Before trying to conceive, talk to your neurologist and obstetrician/gynecologist (OB/GYN). They may decide to change your seizure medication before pregnancy to ensure that you’re using the safest one. 

Also, they will need to take a blood test to determine how much medication is in your blood. This number will act as benchmark — throughout pregnancy, your physician will have you get blood tests so they can try to keep that number stable. With most medications, you will need a blood test once per trimester. However, there are certain medications, such as lamotrigine (Lamictal), which may require more frequent checks. 

2. Myth: It’s hard to get pregnant if you have epilepsy.

Fact: Nope!

Until recently, studies suggested that women with epilepsy may have fertility problems. But newer research shows that unless you have a prior history of infertility, or a different medical condition that can affect fertility, you have the same likelihood of conceiving as women who don’t have epilepsy.

3. Myth: I can’t take epilepsy medication during pregnancy.

Fact: You can. In fact, neurologists usually recommend continuing epilepsy medications throughout pregnancy. However, it comes down to the type of medication. You may need to adjust your dosage or switch to a new drug, but you probably won’t need to stop medication altogether.

Some epilepsy drugs are less often recommended for pregnant women because they can cause developmental problems or birth defects, like cleft lip or spina bifida. Medications associated with the greatest risks include:

  • Valproic acid (Depakote)
  • Topiramate (Topamax)
  • Phenobarbital
  • Phenytoin

Certain epilepsy medications, such as phenytoin and phenobarbital, can increase the risk of your newborn having a bleeding disorder. But if you take prenatal vitamins containing vitamin D, and your baby receives vitamin K, it’s rare for that to happen.

Even if you are taking one of these medications, your physician will likely recommend switching to an alternative, rather than stopping medication entirely. You should always discuss medications with your physician before making any changes.

4. Myth: If I have epilepsy, my baby will have it, too.

Fact: It isn’t likely. 

Epilepsy sometimes runs in families, but don’t panic — most children don’t inherit epilepsy from their parents. In the general population, there’s about a 1% risk of a child developing epilepsy at some point in life. If you have epilepsy, the risk isn’t much higher. It goes up to about 5%. It does increase a little more if the father also has epilepsy, but not by much.

It’s also more likely for your child to develop epilepsy if your own epilepsy was inherited. If you’re concerned about the risk, talk to your doctor about seeing a genetic counselor. 

Remember — even if your child does develop epilepsy, most children can gain complete control over their seizures and lead normal lives

5. Myth: Getting pregnant isn’t safe if you have epilepsy. It causes more seizures.

Fact: There are risks, but these can usually be controlled. The majority of pregnant women have the same seizure frequency during pregnancy. In fact, some women even have fewer seizures.

However, some women do have more seizures during pregnancy. This can happen for a few reasons:

  • Your body goes through many physiological, hormonal, and psychological changes during pregnancy. All of these can contribute to your likelihood of having a seizure. 
  • Physiological changes during pregnancy can alter how your body responds to epilepsy medication, making the medication less effective.
  • Nausea and vomiting are common during pregnancy. You may throw up your epilepsy medication before your body has absorbed it.
  • Weight gain also occurs during pregnancy, and weight is often a factor in your medication dosage. If your weight changes significantly, you might need to increase your dosage.
  • Pregnancy can cause emotional stress or affect your sleeping patterns, and high stress and not enough sleep are both seizure triggers.

Also, some women with epilepsy have a slightly higher risk for having preeclampsia, which is high blood pressure that develops during pregnancy.

6. Myth: If I have a seizure while pregnant, I’ll miscarry.

Fact: Not necessarily.

Having a seizure while pregnant can be scary because of the potential consequences. Falling on your stomach during a seizure could injure the baby. Some seizures can even induce premature labor or a miscarriage.

However, most women who have seizures while pregnant still give birth to healthy babies.

As soon as you find out you’re pregnant, talk to your OB/GYN and your neurologist about what to do if you have a seizure.

7. Myth: I will have to have a C-section.

Fact: In general, epilepsy has no impact on your delivery method. Just like women without epilepsy, you can have your baby vaginally or via Cesarean-section (C-section) — it’s up to you and your physician.

If you have repeated seizures while in labor, your physician may choose to do a C-section.

8. Myth: I won’t be able to breastfeed.

Fact: It’s actually recommended by major organizations like the American Academy of Pediatrics and American Academy of Neurology that you do breastfeed.

The old school of thought was that breastfeeding while on epilepsy medication was not a good idea. But studies from the past decade have shown that babies only get a tiny bit of their mom’s medicine through breast milk — even less than what they got during pregnancy — and that there is little or no risk of side effects.

However, there are a few medications that make it a little risky to breastfeed, including phenobarbital, primidone, lorazepam, and ethosuximide. You may still be able to, but you will need to be extra cautious and monitor your baby for their sleepiness, level of alertness, not gaining weight, or other developmental problems.

The Bottom Line: Here’s What You Can Do to Have a Healthy Pregnancy

Every woman needs to give herself and her health extra care during pregnancy. And if you have epilepsy, it’s especially important to not skip that.

Start by getting the right care team who is willing to work together. The more your OB/GYN and neurologist collaborate with each other, the stronger your care will be.

In addition, it’s a good idea to:

  • Discuss pregnancy with your OB/GYN and neurologist before you start trying to become pregnant.
  • Take prenatal vitamins and folic acid to lower the risk of birth defects. These supplements should be started before pregnancy and continued throughout the pregnancy.
  • Keep up regular appointments with your care team to get your seizure medication levels checked. During pregnancy you will need more frequent monitoring of seizure medication levels.
  • Do not stop, start, or alter the dose of any medication without talking to your physician.
  • Make an extra effort to get more sleep.

Keep up a healthy lifestyle. That means exercising, eating well, and saying no to alcohol and tobacco.

And of course, never hesitate to reach out to your OB/GYN and neurologist with any questions. If you have epilepsy and are pregnant or considering becoming pregnant, it’s time to talk to your neurologist.

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