People with epilepsy, a neurological disorder characterized by recurrent seizures, can have children. Successful pregnancy and parenthood outcomes depend heavily on careful planning, open communication, and specialized medical management. Collaboration between a neurologist and an obstetrician is essential for navigating the unique considerations of an epilepsy diagnosis during the reproductive years. With advances in medication and care protocols, most women with epilepsy experience healthy pregnancies and deliver healthy babies.
Pre-Conception Planning and Fertility
Fertility rates for women with epilepsy are comparable to those of the general population. While some older antiepileptic medications or underlying conditions like Polycystic Ovary Syndrome (PCOS) may slightly affect hormone levels, these factors do not prevent most people from conceiving. Seeking pre-conception counseling with both an epilepsy specialist and an obstetrician, ideally six to twelve months before attempting pregnancy, allows for medication adjustments to optimize seizure control on the safest possible regimen. This preparation includes starting high-dose folic acid supplementation (4 to 5 mg per day) at least one month before conception to reduce the risk of birth defects and improve neurodevelopmental outcomes in the child.
Managing Seizure Activity During Pregnancy
The physiological changes of pregnancy can influence seizure frequency, though about two-thirds of women with epilepsy will see no change in their seizure pattern. Hormonal shifts, increased metabolism of medications, and sleep deprivation can all be factors that affect seizure control. Seizure frequency may decrease for some or increase for others, underscoring the need for close monitoring throughout the nine months. Maintaining seizure control is important, as generalized tonic-clonic seizures pose a significant risk to both the mother and the developing fetus, potentially leading to injury from falls or brief periods of reduced oxygen (hypoxia).
During labor and delivery, the care team works to ensure the mother’s antiepileptic medication schedule is strictly maintained, and specific protocols are in place should a seizure occur during birth.
Antiepileptic Medications and Fetal Development
The primary medical concern during pregnancy involves the potential for antiepileptic drugs (AEDs) to be teratogenic, meaning they can cause birth defects. This risk varies significantly depending on the specific drug and its dosage. Current guidelines recommend using the lowest effective dose (LED) and prioritizing monotherapy (one medication) over polytherapy (a combination of drugs).
Exposure to multiple AEDs is associated with a three-fold increase in the risk of major congenital malformations compared to monotherapy. Older-generation drugs, most notably valproate, carry the highest risk for both major birth defects and long-term neurodevelopmental issues, including lower IQ and developmental delay. Newer-generation AEDs such as lamotrigine and levetiracetam are associated with the lowest risk, often comparable to the background risk in the general population.
Monitoring Medication Levels
Specialized monitoring is necessary throughout the pregnancy to manage this risk-benefit analysis. Therapeutic drug monitoring involves regularly checking the concentration of the AED in the mother’s blood to ensure it remains within the optimal range for seizure prevention. High-level ultrasound screening, often performed in the second trimester, is used to look for any signs of anatomical malformations in the developing fetus.
Understanding the Hereditary Risk
The concern about passing epilepsy on to a child exists, but the hereditary risk for most people with epilepsy is low. The risk of a child developing epilepsy is about 1% in the general population, and for a child with one affected parent, this risk increases only slightly, to a range of 2% to 5%. The probability depends heavily on the specific type of epilepsy and whether a genetic cause has been identified. In cases of complex or familial epilepsy syndromes, genetic counseling can provide a more individualized assessment and help the family understand the inheritance patterns involved.
Postpartum Care and Infant Safety
The postpartum period introduces new challenges, particularly managing sleep deprivation, a common seizure trigger, while caring for a newborn. It is important to establish a care plan that ensures the mother receives adequate, uninterrupted sleep, often by sharing night-time duties with a partner or support person. The mother’s AED levels, which may have fluctuated during pregnancy, need to be closely monitored and adjusted back to non-pregnancy levels by the neurologist.
Breastfeeding is safe and encouraged for mothers taking antiepileptic medications. Most AEDs transfer into breast milk in only small amounts, and studies show that the neurodevelopmental and immunological benefits of breastfeeding outweigh the minimal risk of drug exposure. The concentration of the medication in the infant’s bloodstream is substantially lower than the exposure they experienced in utero.
Parents with epilepsy can implement practical safety measures to minimize risk during infant care:
- Change the baby’s diaper or clothing on a mat on the floor instead of a raised changing table.
- When alone, sit on the floor or a low chair while feeding the baby to prevent a fall from a height should a seizure occur.
- Bathing the infant should only be done when another adult is present.
- Use a sponge bath technique to eliminate the risk of the baby slipping underwater.