No one wants to schedule an unnecessary doctor’s appointment. But as Dr. Lado explains, talking to your doctor far in advance of actually trying to get pregnant is key, since seizure medication can impact the early stages of pregnancy.
"The formation of fetal organs happens very early in pregnancy—usually in the first 12 weeks—so we really want to have your medications worked out and have a plan in place," he explains. Getting on the right medication with the least amount of potential effects on your baby is crucial, but the process of switching medications to find that sweet spot where seizures are under control can take time. "Have the conversation with your seizure doctor beforehand, so that we can make those changes before the pregnancy starts," he recommends.
This step is especially important, since each patient's individual needs differ. "Every woman is different, and the issues and seizure types in each pregnancy are different,” says Dr. Lado. When a patient who has seizures wants to become pregnant, Dr. Lado says her epileptologist will look at what type of seizures she has, how good her seizure control is, how many seizure medicines she is taking, whether or not these are the ones best for pregnancy, and which of those medicines should be switched. While there’s no direct correlation between hormonal changes during pregnancy and the frequency of seizures, your doctor will need to adjust the dosage of your medication as the pregnancy progresses to keep the level of medication in the blood stable.
If you do become pregnant while you're still on seizure medication, schedule an appointment with your doctor, but don't stop taking your meds in the meantime. "Women who become pregnant are very concerned about the effect of the medication during pregnancy—and think they're doing a good thing by protecting the fetus against exposure to seizure medicine when they stop taking it—but exposure to the seizures can be just as or more dangerous than exposure to the medications," Dr. Lado explains. So keep taking the medication but do speak with your doctor as soon as possible after becoming pregnant to make sure they are safe for pregnancy.