If you're among the 800,000 American women of childbearing age with epilepsy, you and your obstetrician will have some medical decisions to make. The crux of the dilemma is that anti-epileptic medications used to prevent seizures create a medically significant risk to your child and not taking these drugs could result in your having convulsions that could also damage an unborn infant. Before stopping or starting medications for epilepsy, you should talk with your doctor.
Before you decide to conceive, consult your neurologist about your medications. It's possible you may not need to take anti-epileptic medications during pregnancy if you've been seizure-free for several years and have normal brain waves. In general, women with epilepsy have twice the risk of giving birth to a baby with congenital anomalies as a woman who doesn't have epilepsy, but anti-epileptic medications account for only part of this increased risk.
If you do need medication, you may be able to reduce the risk of birth defects significantly by changing from a combination of two or more drugs to a single anticonvulsant, or by taking lower, more frequent doses of your medication. Ask your doctor about these possibilities.
You should also remember that if you need to use Dilantin or Mesantoin (a class of medications called hydantoins) your chances of having a healthy, normal baby are almost 90%, while the prospect of a positive pregnancy outcome is even higher if you use phenobarbital.
If you choose pregnancy, the doctor should do a maternal serum alpha-fetoprotein test between weeks 15 and 18 to check for neural tube defects (which include spina bifida), especially if you used valproic acid during your first three months of pregnancy. To safeguard against this problem, you should start supplements of folic acid before you conceive and continue to take them during pregnancy.
You can help researchers gain more insight into epilepsy and pregnancy by enrolling in the Antiepileptic Drug Pregnancy Registry.
Last updated July 01, 2009