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5 Things to Consider if You Have Epilepsy and Want to Have a Baby

Planning ahead is key to a healthy pregnancy.

Young couple laying on a bed together.
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A doctor sitting at a desk holding a model of a brain while explaining something to a person sitting across the desk.

Northwell Health Institute for Neurology and Neurosurgery

Around 3.4 million people in the U.S. are living with epilepsy—a neurological condition that causes seizures. While it's a scary diagnosis to get and a challenging condition to live with, there is good news. Thankfully, there's been plenty of research done on epilepsy, and the seizure medications of today are usually very effective at keeping this condition under control.

It's a common misconception that experts caution against getting pregnant when you have epilepsy. While there are some added precautions you should take if you have the condition, a healthy, successful pregnancy is absolutely possible. Northwell Health epilepsy specialist Dr. Fred Lado has helped plenty of patients make their baby dreams a reality. "As an epileptologist, part of my job is taking care of people with seizures who are pregnant or plan to become pregnant, paying special attention to the issues that come up during pregnancy regarding seizure control," he says.

If you have epilepsy and want to start a family, here are five important factors to consider before you conceive:

1. How epilepsy impacts fertility

Does having epilepsy make it harder to get pregnant? The short answer is yes—but it is possible with help from your doctor. "Epilepsy originates from abnormal activity in the brain, and sometimes that abnormal activity causes the brain to incorrectly regulate fertility hormones like estrogen and progesterone. When that happens, the eggs and ovaries don't mature normally because the hormonal environment is too irregular," explains Dr. Lado. To address this, women with epilepsy work closely with their obstetrician to identify whether hormone levels are adequate for pregnancy and explore options such as in vitro if necessary.

There are certain seizure medications that have been found to correlate with lower fertility potential as well; Dr. Lado suggests discussing the different medications on the market with your doctor before trying to get pregnant in order to find the right one for you.

2. When to consult your doctor

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.

3. How seizures can impact pregnancy

Controlling seizures with the right medication for pregnancy before you conceive greatly reduces any seizure-related risk to the baby. The results of having a seizure during pregnancy can vary by patient and seizure type. "For small seizures, such as a confusional spell or staring spell there is not a lot of risk to the pregnancy," Dr. Lado explains. "There may be some hormonal changes that are relatively mild, but overall we don't think there's a great strain put on the fetus."

Convulsions are more worrisome. "When a person has a convulsion, it can decrease blood flow to the placenta temporarily, and that's not healthy for the fetus," says Dr. Lado. "Because most seizures are quick and typically last no longer than three minutes at most, the period of distress for the fetus is relatively brief. Nevertheless, we want to keep the mother safe from seizures and also minimize any stress to the fetus with the right dosage of medication."

4. Work with your doctor during pregnancy

Once you've determined the right medication to control your seizures during pregnancy, your doctor will likely adjust the dosage throughout each trimester based on the needs of you and your baby.

"In the second trimester the fetus is getting larger, which means the metabolism of medications changes a lot," Dr. Lado explains. "We want to make sure that the mother's medication levels are stable, and that we're changing the dose to adjust the amount of medication so that the levels in circulation remain stable."

"During the third trimester we continue adjusting medication," Dr. Lado says. "As we're approaching delivery, we work with the obstetrician to have a plan in place." This includes evaluating medications used during labor and identifying any specific needs of the patient to keep seizures controlled for the duration of it. "Sometimes patients may not be able to take medications orally going into delivery or following delivery, so we may need to give medication intravenously," Dr. Lado says.

5. You can (and should) breastfeed your baby

Another myth about epilepsy is that women shouldn't breastfeed. But that’s not the case, says Dr. Lado. "When you're breastfeeding, your baby is exposed to a very small amount of the medication," he explains. "Breast milk is very nutritious, and breastfeeding is an important period of bonding between mother and baby, so the benefits of breastfeeding far outweigh the small risks of exposure."

As for the long-term effects of exposure to epilepsy medicine in the womb, Dr. Lado says epileptologists know which medications to steer clear of in order to avoid any potential complications. "We want to make sure that women are on the best medicines not just during pregnancy but afterward too, so that they can breastfeed with minimal risk."

Bottom line? There’s no reason epilepsy should stand in the way of you and motherhood. "Pregnancy for women with seizure disorders requires more planning," Dr. Lado says. "But the vast majority of women with epilepsy carry pregnancy to term and go on to make a happy, healthy family."

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Published April 2nd, 2019
A doctor sitting at a desk holding a model of a brain while explaining something to a person sitting across the desk.

Northwell Health Institute for Neurology and Neurosurgery