If you have epilepsy you may be nervous about what it means for your pregnancy and baby.
Try not to worry, most women with epilepsy will have a healthy pregnancy and go on to have a healthy baby. But there is a slightly higher risk of having a baby with a birth defect or developmental problem, so it's important to get the right support.
If you find out you're pregnant, don't stop taking your anti-epilepsy medicine until you've spoken with your doctor or specialist.
Planning on getting pregnant
If you're taking anti-epileptic drugs (AEDs) and you're planning to get pregnant, you should continue to use contraception and take your medication until you discuss your plans with your GP or neurologist.
This is because your doctor may want to make changes to the dose or type of medicine you are taking, which is best done before you become pregnant.
You should also be offered pre-conception counselling, which will help you understand any risks and plan for a healthy pregnancy and baby.
Effect of pregnancy on your epilepsy
It's difficult to predict how pregnancy will affect epilepsy. For some women their epilepsy is unaffected, while others may see an improvement in their condition.
However, as pregnancy can cause physical and emotional stress, as well as increased tiredness, your seizures may become more frequent and severe. If this happens to you, let your doctor, midwife or epilepsy specialist know.
Risks from epilepsy medicines
Research has shown that there is a slightly increased risk of your child not developing normally if you've taken some types of AED during pregnancy. This may cause problems such as spina bifida, cleft lip, or heart abnormalities.
Some medicines may also give your baby a higher chance of brain development problems, such as a delay in developing speech and language, and problems with memory and attention.
To reduce these risks, talk to your GP or neurologist about your medicines before you get pregnant or if you're planning to get pregnant. They may want to switch you to an alternative treatment. It's usually better to make any changes to your medication before rather than during pregnancy.
If you get pregnant while you're taking an AED, continue to take it and contact your GP or specialist immediately to discuss your treatment.
Don't alter your treatment or stop taking your medication without specialist advice, especially during pregnancy. This is because a severe seizure in pregnancy could result in harm or injury to you or your baby.
The risk of harm to your baby is higher with certain AEDs, such as sodium valproate, than with others.
If you're taking sodium valproate and are planning to get pregnant or find out that you are pregnant, don't stop taking your medication. See your GP or neurologist immediately to discuss your increased risk and whether this is still the best treatment for you.
Women and girls who are able to get pregnant must not be given sodium valproate unless they have enrolled in a "pregnancy prevention programme". This is designed to make sure they understand:
- the risks of taking sodium valproate in pregnancy
- the need to use effective contraception to prevent pregnancy
As part of a pregnancy prevention programme, you'll need to:
- see your consultant at least once a year to discuss your treatment
- discuss the risks of sodium valproate and the importance of avoiding pregnancy
- sign a form stating you understand the risks to your unborn baby if you take sodium valproate, and agree to use effective contraception throughout your treatment
Your doctor may refer you to contraception services.
Your doctor will give you an information leaflet to explain more about the risks and how to avoid them. Keep this information in case you need to refer to it again.
Read more about the risks of taking sodium valproate in pregnancy.
If you're taking medication to control your epilepsy, you will need to take 5 milligram (5mg) of folic acid once a day as soon as you start trying for a baby.
This will need to be prescribed for you, usually by your GP, as it is a higher dose than normal.
If you become pregnant unexpectedly and haven't been taking folic acid, make an appointment with your GP and start taking it straight away. You can buy the lower dose 400 microgram tablets from a pharmacy before you get a prescription for the 5mg tablets.
Talk to your GP or pharmacist if you need any advice.
Your care during pregnancy
Before you become pregnant, or as early in your pregnancy as possible, you'll be referred to an obstetrician, who will discuss and plan your care during pregnancy. If necessary, a neurologist may also be involved in putting this plan together.
You'll be offered the same ultrasound scans as all pregnant women to help detect any developmental problems in your baby. But you will usually need to visit the clinic more often than other pregnant women. You may need extra scans or blood tests, to check the level of anti-epileptic medication in your blood, depending on which AEDs you take.
You may be worried about your baby inheriting your epilepsy. You can talk to your care team about this and any other concerns you have.
If you're well, it's really important you go to all your appointments and scans for the health of you and your baby.
Hospitals and clinics are making sure it's safe for pregnant women to go to appointments.
If you get symptoms of coronavirus, or you're unwell with something other than coronavirus, speak to your midwife or maternity team. They will advise you what to do.
Labour, birth and beyond
Depending on your risk of having a seizure during labour your doctors will usually recommend that you give birth in a consultant-led maternity unit in hospital.
See where can I give birth? for more information about giving birth in hospital.
During labour you'll be looked after by a midwife, and doctors will be available if you need their help. You should bring your epilepsy medicine with you to the hospital and continue to take it as you normally would.
Read about what happens in labour.
If you are taking certain kinds of AED, you’ll be offered a vitamin K injection for your baby soon after birth to help their blood to clot.
There's usually no reason why you can't breastfeed your baby. Even if some of your medication gets into your milk, the benefits of breastfeeding often outweigh any risks. Your midwife, obstetrician or pharmacist can give you advice based on your circumstances.
The UK Epilepsy and Pregnancy Register
This nationwide project is investigating which epilepsy treatments pose the lowest risk to a baby's health. Any pregnant women with epilepsy can join the UK Epilepsy and Pregnancy Register.
When you register, you'll be asked to provide information about the treatment you're taking. Information about the health of your baby will be collected after your baby is born. This helps doctors give the best advice to women who are thinking of getting pregnant.
Video: giving birth in hospital
This video discusses giving birth in a hospital.
Media review due: 12 October 2021