Pregnancy

Every woman in the United States who becomes pregnant runs a 2 to 3% risk of having a child with a major birth defect.

Like other women, the overwhelming majority of women who have epilepsy also give birth to normal, healthy infants. However, their risk of major birth defects is about two to three times higher than the average, that is, from 4 to 6%.

The reason for the higher rate is not completely understood. It may be the effect of epilepsy drugs on susceptible people. It may be that epilepsy and seizures have effects on fetal development that have not yet been identified.

New information on this issue is being developed all the time. For example, we now know there is a higher risk if a woman is taking several seizure-preventing medicines at relatively high doses. Since most birth defects develop in the early weeks of pregnancy, it is a good idea to discuss these issues with your doctor before the pregnancy begins.

This will give him or her an opportunity to review your treatment and discuss any possible risks with you. The U.S. Public Health Service recommends that all women of child bearing age take folic acid supplements to reduce the risk of certain birth defects. Your doctor may want to prescribe pre-natal vitamins and higher doses of folic acid if you are taking antiseizure medicines.

If you have had good seizure control for some time, you and your doctor may want to talk about adjusting, or even stopping, your medications before you become pregnant.

However, women who find out they are pregnant while taking seizure-preventing drugs should not panic and stop the drugs abruptly. Doing that could cause severe, non-stop seizures that could injure the mother and the developing child.

In most cases, the doctor will not advise discontinuation of seizure medicine during pregnancy. That's because it will still be necessary to prevent seizures that could harm the mother or the baby.

This is an important issue and of great concern to young women who want to have children. But it's also important to remember that more than 90 percent of women with epilepsy give birth to normal, healthy infants.

What about the impact of pregnancy itself? Some women have more seizures than usual when they are pregnant; some have fewer; and others find that pregnancy does not change their seizure experience at all.

Birth control

Most women with epilepsy can use normal methods of birth control (including birth control pills, implants, and injections). However, you should always tell the doctor who is prescribing hormones for birth control for you that you have epilepsy and you are taking medicine for it.

That's because about half of the antiseizure drugs interact with hormonal therapy, which can result in lowering the effectiveness of the birth control medication. Talk to your doctor about which method of birth control and which antiseizure medicine might be best for you.