What is epilepsy during pregnancy?

Epilepsy is a disorder of the nervous system. It is also called a seizure disorder. Normally the body's nerves send information by electrical and chemical signals. People with epilepsy have abnormal electrical signals in the brain. This can cause a seizure. Seizures can cause severe shaking of muscles. Or they may be very mild with hardly any symptoms at all.

Women who have epilepsy tend to have more seizures when they are pregnant. This is especially true in women who already have a lot of seizures.

What causes epilepsy during pregnancy?

Pregnancy does not cause epilepsy. But a pregnant woman who has epilepsy may have seizures more often. This may be because medicines to treat epilepsy can work differently during pregnancy. They may not be absorbed as well. Or they may not work as well. Also women who have nausea and vomiting in early pregnancy may vomit the medicine before it has its full effect.

What are the symptoms of epilepsy during pregnancy?

The symptoms are no different from symptoms when a woman is not pregnant. A woman with epilepsy has frequent or regular seizures with no known cause. In addition to seizures, the most common symptoms include:

• Headache

• Changes in mood or energy level

• Dizziness

• Fainting

• Confusion

• Memory loss

Some women may also have an aura. This is a feeling that they are going to have a seizure right before it happens.

The symptoms of epilepsy may look like other health conditions. Always see your healthcare provider for a diagnosis.

How is epilepsy during pregnancy diagnosed?

Most women with epilepsy will have been diagnosed before pregnancy. The diagnosis of epilepsy is based on a health history and physical exam. The diagnosis can only be made after you have had more than one seizure. Your healthcare provider may order tests based on how often you have seizures. These tests may include blood tests, heart (ECG) and brain wave (EEG) tests, and a CT scan or MRI.

How is epilepsy during pregnancy treated?

If you have epilepsy and are pregnant, you may need to see your healthcare provider more often. You most likely will be given medicine to prevent seizures. Keeping track of these medicines is important to control seizures and reduce side effects. Your healthcare provider will use as few medicines as possible and at the lowest dose needed to control seizures. Never stop or reduce your seizure medicine unless your healthcare provider tells you to.  

You will likely have a normal labor and delivery. But stress may raise the risk for seizures. A calm birthing setting and epidural anesthesia can help.

You can raise your chances for a healthy pregnancy by getting early prenatal care. Work with your healthcare providers to manage your epilepsy.

What are possible complications of epilepsy during pregnancy?

Epilepsy and the medicines to treat it can have many effects on the mother, the pregnancy, and the developing baby. Most women are able to have a healthy pregnancy and baby. But epilepsy does raise the risk for certain complications of pregnancy. These include:

• High blood pressure of pregnancy

• Stillbirth

• Slightly smaller baby

• Birth defects of the spine and brain (neural tube defects). Some epilepsy medicine may interfere with the levels of folic acid in the blood. Folic acid is a B vitamin. All women of childbearing age should take folic acid supplements of 0.4 mg per day to prevent neural tube defects. If you take epilepsy medicine, talk with your healthcare provider about taking a higher dose of folic acid. It may help prevent these defects.

• Other birth defects. These may be linked to some epilepsy medicines. Most experts agree that preventing seizures is better than the risks of taking the medicines. Most babies born to women taking epilepsy medicines do not have birth defects.

• Lower levels of vitamin D. Epilepsy medicine can affect how well your body absorbs vitamin D. Taking prenatal vitamins generally takes care of this problem.

• Severe bleeding in the newborn. Some epilepsy medicines can affect the levels of vitamin K, which is important in blood clotting. All newborns should get a shot of vitamin K to prevent bleeding. 

• Withdrawal symptoms in the newborn. These are from the mother's seizure medicine. Symptoms last only a few weeks or months. They usually do not cause serious or long-term problems.

• Sleeping or feeding problems. Newborns who are breastfed may be very sleepy or have feeding problems. This is because the seizure medicine is passed through breastmilk. Generally, the benefits of breastfeeding are greater than any side effects for the baby.

When should I call my healthcare provider?

If you start having more frequent seizures, see your healthcare provider.

Key points about epilepsy during pregnancy

• Although pregnancy does not cause epilepsy, women with epilepsy tend to have seizures more often in pregnancy.

• Epilepsy and the medicines to treat it can have many effects on the mother, the pregnancy, and the developing baby.

• Most women with epilepsy are able to have a healthy pregnancy and baby.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.