If you have epilepsy and are pregnant or are thinking about becoming pregnant, you probably have lots of questions about how it might impact you and your baby.

The Ohio State Comprehensive Epilepsy Center will carefully monitor you before, during and after your pregnancy, and our experts are here to help answer all the questions you have.

Specialized pregnancy care at Ohio State

Pregnant women with epilepsy benefit from coordinated care at The Ohio State University Wexner Medical Center in two important ways:

• Your regular epilepsy team and our maternal fetal medicine doctors in our Epilepsy Pregnancy Clinic work together to make sure both you and your baby are continually monitored for any potential health risks.
• Your epilepsy medications will be carefully managed to continue seizure control while minimizing the effects of medication on your baby.

Of course, you’ll still have lots of questions, concerns and plenty of physical changes — but that’s normal for any pregnancy.

At Ohio State, we’ll do all we can to help you have a safe, joyful pregnancy.

Pregnancy and seizures

• Most women with epilepsy are surprised to learn that they will likely have the same number of seizures during pregnancy as they did leading up to their pregnancy.
• In addition, women who haven't had any seizures in the nine months before their pregnancy have a high chance of remaining seizure-free during their pregnancy.
• A small percentage of women with epilepsy — about 15-30% — may face an increase in their seizures during pregnancy.

Our goal is to be proactive from the start of your pregnancy and work together to make sure we’re doing all we can to minimize your risks.

Before pregnancy

If possible, it’s a great idea to talk with your epileptologist before becoming pregnant so we can develop a plan.

• Some anti-seizure medications might increase fertility, while others might reduce the effectiveness of hormone-based birth control.
• We may also want you to start taking folic acid prior to conception — which is useful for all women wanting to become pregnant — as well as other supplements. We’ll determine the right doses based on your health.
• Depending on your family history of genetic conditions, it may also be helpful to conduct genetic counseling.

We can also discuss how your current prescriptions might affect your baby. This can be different based on the anti-seizure medication you are on.

• There’s a 2% risk of a birth defect for babies born to moms without epilepsy. This increases when on an anti-seizure medication.
• The most common birth defects include cleft lip or cleft palate, which can usually be corrected with surgery. Heart, neural tube, reproductive organ and urinary tract defects as well as skeletal abnormalities may also be associated with anti-seizure medications.
• To reduce these risks further, we may adjust dosage amounts, change your prescription or reduce the number of medications you’re taking.

If you’re already pregnant, don’t panic. It’s extremely common for women with epilepsy to become pregnant before making any changes to their epilepsy treatment. There’ll be plenty of time to adjust your care and address any issues from your first prenatal visit forward.

During pregnancy

You likely already know some of your seizure triggers, and we’ll continue to help you with those throughout your pregnancy. In addition, we’ll be on the lookout for potential triggers that may happen as your pregnancy progresses, including hormone changes, lack of sleep, retention of water or sodium, increased stress or anxiety and fluctuations of anti-seizure medication levels in your blood.

If we do have to increase your medications during your pregnancy, we will provide you with a postpartum plan to help you decrease your medications to their pre-pregnancy dose after delivery.

What are the risks of seizures while pregnant?

Some of the main risks with seizures during pregnancy include trauma from falls or burns, a greater chance of premature labor or miscarriage and lower fetal heart rate or oxygen levels. Knowing these risks isn’t intended to add to your worry, but instead add to your awareness. This is the best way to be proactive and try to reduce the risks or prevent seizures from happening in the first place.

Can you take anti-seizure medication while pregnant?

Yes — if you’re able to have a planned pregnancy, we can work with you to ensure that you're on the right anti-seizure medication at the right dose. If you find out that you are pregnant, please don’t make any changes to your medications without talking to your neurologist or epileptologist.

Monitoring your baby’s progress

We’ll always try to prescribe the most effective drug with the fewest side effects.

Your maternal fetal medicine doctor will screen your baby regularly with routine exams and checks, such as maternal serum alpha-fetoprotein testing and high-resolution ultrasounds.

Labor and delivery

Pregnant women with epilepsy have every reason to expect a normal labor and delivery. A diagnosis of epilepsy alone doesn’t increase the likelihood of a cesarean birth. Most women with epilepsy are able to have a normal vaginal delivery.

Can you have an epidural if you have epilepsy?

The same methods of pain relief available to other pregnant women are likely to be an option for you as well.

What if you have a seizure during labor?

Seizures aren’t common during labor. However, if one does occur, there are IV medicines we can use to help stop a seizure from progressing for a long period of time.

If your or your baby’s health is ever in jeopardy because of a prolonged seizure, we’ll adjust the delivery plan, the same approach taken for women without epilepsy who have a complication during labor and delivery.

After delivery and life as a mom with epilepsy

After delivery, we’ll follow up to discuss the timing of any adjustments to your medication to return you to pre-pregnancy dosages.

Can you breastfeed while taking epilepsy medication?

We typically encourage breastfeeding for any moms interested in doing so because of the health benefits to the baby and to the mother. Not only has the baby already been exposed to your anti-seizure drugs, but the amount of drug in breastmilk is typically quite low.

You’re not alone

We have easy strategies for baby care to boost your confidence and comfort. We want you to embrace your new role and recognize that every mother faces challenges.

Simple adjustments, like changing diapers on the floor or having someone else bathe the baby or stay with you as you do the bathing, are easy ways that moms with epilepsy have safely navigated the infant years.

Support groups

Support from other parents with epilepsy might be helpful. You can rely on the resources you already have or you can check out the online community forum4e or myepilepystory.org. You can also read the experiences of other moms with epilepsy at pregnancy diaries.

Don’t forget to take care of you

It’s impossible to overemphasize the self-care required after becoming a mom. Here’s our tip sheet as you enter this next stage of life:

• Continue to take your epilepsy medicine as prescribed
• Keep every scheduled health care appointment
• Nap when your baby naps
• Eat healthy meals regularly and stay hydrated
• Most importantly, ask for help

Every new mom has questions and needs support — with or without epilepsy

The epilepsy team at Ohio State looks forward to talking with you more about your pregnancy concerns. Along with the specialists in our Epilepsy Pregnancy Clinic, we’re ready to help you enjoy every aspect of your pregnancy and newborn parenting.