FAQ Pregnancy
FAQ129, February 2013



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Seizure Disorders in Pregnancy

What is a seizure?

A seizure occurs when the activity of nerve cells in the brain becomes abnormal. A seizure can cause a change in mood, emotions, consciousness, or movement.

What is epilepsy?

Epilepsy is one kind of seizure disorder. It is diagnosed when a person has two or more seizures that have no clear cause.

Can seizures be controlled?

People who have repeated seizures usually need to take antiepileptic drugs (AEDs) or "antiseizure" drugs. These drugs do not cure the disorder, but they can prevent seizures all or most of the time. There are more than 20 different AEDs. The choice of drug is based on a patient’s age, the type of seizure, and the side effects of the drug. If one drug does not work, another can be tried. More than one drug may be needed to control seizures.

If I have a seizure disorder, can it cause problems during pregnancy?

Seizure disorders can affect pregnancy in several ways:

  • Women with seizure disorders have a higher risk of having a child with a birth defect than women who do not have seizure disorders. This increased risk may be related to the seizure disorder itself or to some of the AEDs used to treat it.
  • Having a seizure during pregnancy can cause injury to you and your baby.
  • Pregnancy can change the frequency of seizures. Most women will have no changes in seizure frequency or will have seizures less often. One third will have seizures more often.

Many of these problems can be minimized or avoided by getting good medical care before and during pregnancy.

What risks are associated with having a seizure during pregnancy?

Seizures can harm not only the woman, but also her baby. Seizures that cause a loss of consciousness and violent, jerking movements, called grand mal seizures, are especially hazardous during pregnancy. The risks associated with seizures during pregnancy include injury from falls, decreased oxygen to the baby during the seizure, preterm labor, and preterm birth.

Can taking antiseizure medications during pregnancy harm my baby?

Some AEDs have been associated with a small increased risk of birth defects, including cleft lip or palate (the lip or roof of the mouth is not completely closed), heart defects, and neural tube defects. One reason why AEDs may be related to an increased risk of birth defects is that many of these drugs affect the way the body uses folic acid. Folic acid is a B vitamin. Not having enough folic acid before pregnancy and during the first weeks of pregnancy can increase the risk of having a child with a neural tube defect. If you take an AED, your health care provider may recommend that you take extra folic acid before pregnancy and for the first 3 months of pregnancy.

Should I stop taking my antiseizure medications during pregnancy?

Because there are serious risks associated with having a seizure during pregnancy and because the potential risk of harm to your baby from taking AEDs is small, experts recommend that seizures be controlled with AEDs, if necessary, during pregnancy. However, the type, amount, or number of AEDs that you take may need to change. Ideally, any changes in medication should be made before pregnancy. This allows you and your health care provider to see how the medication changes affect you without putting the fetus at risk.

What extra steps may my health care provider take when monitoring my pregnancy?

Blood tests may be done regularly to be sure that medication levels are constant. Levels that are too high can lead to side effects. Levels that are too low can lead to seizures. Blood tests also can be used to screen for certain birth defects. Diagnostic testing, including a targeted ultrasound exam, amniocentesis, or chorionic villus sampling, can be done to determine if certain birth defects are present.

If I have a seizure disorder, will it affect how I have my baby?

Having a seizure disorder does not affect how you will have your baby. Like most women, women with a seizure disorder are able to give birth to their babies vaginally unless a problem arises during labor or delivery. In these cases, a cesarean delivery may be needed.

What do I need to know about using birth control after the baby is born?

AEDs can decrease the effectiveness of some hormonal methods of birth control. These include birth control pills, the vaginal ring, the skin patch, and the implant. Methods that are not affected by AEDs are both types of the intrauterine device, the birth control injection, and barrier methods (such as the diaphragm, spermicide, or condoms). Some women choose to use a barrier method along with a hormonal method. Sterilization is an option if you have completed your family.

Can I breastfeed my baby?

Most women with seizure disorders can breastfeed their babies. AEDs are found in small amounts in breast milk, but in most cases it is not enough to affect the baby.

Glossary

Amniocentesis: A procedure in which a needle is used to withdraw and test a small amount of amniotic fluid and cells from the sac surrounding the fetus.

Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus.

Chorionic Villus Sampling: A procedure in which a small sample of cells is taken from the placenta and tested.

Epilepsy: A group of disorders in which the electrical activity in the brain suddenly becomes abnormal. This can lead to seizures, which are temporary changes in mood, emotions, consciousness, or movement. Epilepsy is diagnosed if a person has two or more seizures that do not have a clear cause.

Fetus: The developing organism in the uterus from the ninth week of pregnancy until the end of pregnancy.

Grand Mal Seizures: A type of seizure that causes loss of consciousness and violent, jerking movements.

Intrauterine Device: A small device that is inserted and left inside the uterus to prevent pregnancy.

Neural Tube Defects: Birth defects that result from incomplete development of the brain, spinal cord, or their coverings.

Preterm: Born before 37 weeks of pregnancy.

Sterilization: A permanent method of birth control.

Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

If you have further questions, contact your obstetrician–gynecologist.

FAQ129: Designed as an aid to patients, this document sets forth current information and opinions related to women’s health. The information does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations, taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice, may be appropriate.

Copyright February 2013 by the American College of Obstetricians and Gynecologists