Planning a baby

There is no reason why most women with epilepsy cannot become pregnant and have a healthy pregnancy. Wherever possible, it is advisable for every pregnancy to be planned, because for women with epilepsy there is a slightly higher risk of complications than in women who don’t have epilepsy. However, with forward planning, these risks may be minimised. You can find more detailed information about this on the risks of AEDs in pregnancy web page.

Pre-conception counselling

If you decide to have a baby it is a good idea to seek medical advice before you conceive, if possible. This is known as pre-conception counselling and is an opportunity to discuss your epilepsy and your anti-epileptic drugs (AEDs), and the risks they may bring to your pregnancy.

An epilepsy specialist nurse or an epilepsy specialist will usually provide your pre-conception counselling. You can ask your family doctor, epilepsy specialist or epilepsy specialist nurse to arrange a separate appointment for this specific purpose.

The advice that you are given will depend very much on the type of epilepsy you have. The aim will be to keep you as seizure free as possible, while trying to reduce any risk of damage to the baby from the drugs you are taking.

The risk of AEDs affecting your unborn child is at its greatest during the first three months of pregnancy. This is why it is advisable to have pre-conception counselling and get your medication reviewed before you become pregnant.

If you become pregnant before you have had any pre-conception counselling, it is important to continue taking your AEDs until you have had an opportunity to discuss your drug treatment with your epilepsy specialist or epilepsy specialist nurse. If you were to stop taking your medication, this could cause you to have an increase in seizures, which may cause more problems than the risks associated with the drugs themselves.

It is advisable to make an appointment to see your family doctor, epilepsy specialist or epilepsy specialist nurse as soon as you find out that you are pregnant.

Folic acid

Many doctors suggest that folic acid supplements of 5mg a day should be taken by women with epilepsy who are planning a family. These should start before conception and be continued throughout the first three months of pregnancy.

As unplanned pregnancies are common, some doctors suggest that any woman with epilepsy who could become pregnant should take 5mg of folic acid daily all the time.

There is some evidence, however, that folic acid can interact with phenytoin, primidone and phenobarbital making them less effective. If you are taking either of these drugs, it is important to seek advice from your family doctor, epilepsy specialist or epilepsy specialist nurse before taking folic acid supplements

The Nice Guideline on the treatment and care of women with epilepsy who may become pregnant.

The following recommendations are based on the NICE guideline – The Epilepsies. The diagnosis and management of the epilepsies in adults and children in primary and secondary care (Oct.04).

• The aim is to be free of seizures during pregnancy, wherever possible.
• If you have simple partial, complex partial, absence or myoclonic seizures during pregnancy, there is no evidence these will harm your developing baby, unless you fall and injure yourself.
• If you have tonic-clonic seizures during pregnancy there is a slightly higher risk of harm to your developing baby. Even here, the risk remains very low, particularly if your seizures are infrequent.
• Although the risk of having seizures during labour is low, the guidelines recommend that all women with epilepsy deliver their babies in hospital.
• If you are taking anti-epileptic drugs, it may be appropriate to take 5 mg a day of folic acid before you become pregnant. You may wish to discuss this with your doctor. (Note: folic acid can alter the way that the drugs phenytoin, primidone and phenobarbital work. If you are taking one of these drugs you will need specific advice from your epilepsy specialist before taking folic acid.)
• If you are planning to stop your anti-epileptic drug treatment during your pregnancy, your doctor should discuss with you the possible risks to you and/or your developing baby.

11 December 2006