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Women with epilepsy were often advised not to fall pregnant. But, with good prenatal care, 90% of women with epilepsy, who do fall pregnant, end up having healthy babies.
Some women with epilepsy may, however experience greater difficulty than other women in falling pregnant. There’s a connection between two specific hormones and epilepsy: oestrogen and progesterone. Oestrogen increases the electrical activity of the brain, and progesterone decreases it.
Is it more difficult for epileptic women to fall pregnant?
It’s a double-edged sword, as the effectiveness of epilepsy treatment may be influenced by a woman’s hormonal state, and a woman’s hormonal state may be affected by epilepsy treatment.
In rare instances, women can experience heightened risk of seizures in the perimenstrual period. However, it’s not certain that this is sufficient to have a major effect on the effectiveness of epilepsy treatment. Some studies suggest that female and male fertility is moderately reduced in patients suffering from epilepsy. Potential factors include the effect of anti-epileptic medication on sex hormones, but also epilepsy itself, comorbid depression and psychosocial factors.
Some anti-epileptic medications, i.e. valproate and gabapentin, can increase appetite and lead to weight gain. Overeating can cause obesity. Obesity can be associated with PCOS, which is frequently associated with menstrual irregularities.
AEDs and the health of your baby
Many women with epilepsy worry about the effect their anti-seizure medication could have on their unborn babies. While there are certainly risks involved, the prevention of seizures during pregnancy remains important, as uncontrolled seizures could deprive the unborn baby of oxygen.
There are risks when taking any seizure medications – a baby could be born with a cleft palate, bone abnormalities, and heart and urinary tract defects. While this sounds very serious, it must be stressed that pregnant women who take AEDs run a minimal risk of having a baby with birth defects.
It’s never a good idea to stop taking or taper off AEDs without talking to your doctor. For most women with epilepsy, it’s best to stay on your AEDs during pregnancy, but you might need to change your types of AED in consultation with your doctor, preferably before you fall pregnant.
It’s essential to try and keep seizures under control, also during pregnancy. Blood levels of anti-epileptic medications can change during pregnancy; so dose adjustments may be necessary.
Many women also worry that their children could inherit the epilepsy. This depends on many factors, such as the type of epilepsy a woman has, whether the epilepsy has a genetic cause, and whether your partner also has epilepsy. Of all babies who are born, only one percent run the risk of becoming epileptic. This increases slightly for children whose parents have epilepsy.
Epilepsy and possible pregnancy complications
The experience of pregnancy is different for every woman, and this is also true for pregnant women with epilepsy. Unfortunately, women with epilepsy have a higher risk of pregnancy-related complications, like morning sickness, high blood pressure (pre-eclampsia), anaemia, premature birth, or a low-weight baby.
It can also happen that during labour and delivery, the progress stops, possibly making a C- ection necessary. For most women with epilepsy, seizures don’t become more frequent during pregnancy, or while giving birth. In women with poorly controlled epilepsy, seizures can sometimes become more frequent.
The risk of having a seizure during the birth process isn’t majorly increased. It's always best though, to have your baby delivered in a hospital with a medical team on standby.
