Pre-conception counselling

If you have epilepsy and are considering having a baby, it is a good idea to seek advice, known as pre-conception counselling, before you get pregnant. Pre-conception counselling provides an opportunity to discuss your epilepsy and medication with a health professional with an interest in epilepsy, usually an epilepsy specialist or an epilepsy specialist nurse. (For more information, see the section Risks of taking anti-epileptic drugs in pregnancy.)

During pre-conception counselling, you will be able to discuss how your epilepsy may affect your pregnancy. It is also an opportunity to consider the risks that your anti-epileptic drugs (AEDs) or uncontrolled seizures may pose to your baby.

In all pregnancies there is a small risk that the mother may die. Each year in the UK, about four women with epilepsy die during pregnancy. This risk is seven times higher than for women without epilepsy. The health professionals involved in studying maternal deaths, believe that the increase in risk may be due in part to women not taking their AEDs as prescribed during pregnancy.

Not taking AEDs can lead to uncontrolled seizures, which increases the risk of sudden unexpected death in epilepsy (SUDEP).

For this reason, during pre-conception counselling, your health professional will try to help you have good seizure control with AEDs that pose the lowest risks to the baby. After considering all the risk factors, your health professional may suggest that you change the amount of AEDs you take. They may advise a change to a different AED or even stop taking AEDs altogether, before you get pregnant. The majority of women with epilepsy have healthy pregnancies and give birth to healthy babies. The advice you will be given will depend on your own circumstances.

• More information about changing anti-epileptic drugs

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 a review of your epilepsy and medication before you become pregnant.

If you become pregnant before you have had any pre-conception counselling, it is important to continue taking your AEDs as usual. Don’t make any changes until you have had an opportunity to talk to your epilepsy specialist or epilepsy specialist nurse. If you stop taking your AEDs, it could cause you to have an increase in seizures, or your seizures may become more severe. This may cause more problems for you and your unborn baby than any 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.

November 2008

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