Epilepsy in pregnancy FAQs

Q.1 WILL MY PREGNANCY BE TREATED AS HIGH RISK?

For most women, their epilepsy remains unchanged during pregnancy. However, some women experience more frequent seizures, a change in seizure severity or pattern or an improvement in their seizure control. This is why your healthcare professionals will want to closely monitor your condition.  The majority of women who currently have epilepsy will be advised to give birth in a hospital maternity unit with consultant obstetric cover.

Q.2 CAN PREGNANCY CAUSE AN INCREASE IN SEIZURES?

If your epilepsy has been well controlled for at least nine months before pregnancy, it is more likely to stay controlled during pregnancy*. Research suggests that pregnant women with focal epilepsy are more likely to have a recurrence of seizures than women with generalised epilepsy**. Blood levels of some antiepileptic drugs (AEDs) reduce during pregnancy causing an increased risk of seizures. Therefore, your specialist may recommend drug monitoring and extra medical supervision, especially if you are taking lamotrigine2.

Suddenly stopping or reducing AED dosage may cause an increase in seizures and a risk to life. If you are concerned about the effect of AEDs on your unborn baby, discuss this urgently with your healthcare team or contact the UK Epilepsy and Pregnancy Register. It’s really important not to stop your AEDs without consulting your health professionals.  

Q.3 WHEN SHOULD I TELL MY GP THAT I AM PREGNANT?

You should see your GP as soon as possible so your epilepsy and treatment can be reviewed. If you are having on-going seizures despite AEDs, your GP will provide advice and arrange for you to be referred to an epilepsy specialist and obstetrician. If you take AEDs and have not started taking a daily dose of 5mgs folic acid, your GP will prescribe this for up to and including the 12th week of pregnancy.

Q.4 WHAT WILL HAPPEN AT MY ANTENATAL BOOKING APPOINTMENT?

You will need to tell the midwife that you have epilepsy and provide a description and the date of your last seizure. If you can, take along someone who has witnessed your seizures who can give an accurate description. You will also need to take your AEDs and repeat prescription. The midwife will also need to know about possible triggers for your seizures. To assist your maternity care, a multi-professional shared care plan will provide a summary of your epilepsy and can be downloaded from:  https://www.epilepsy.org.uk opens in a new tab/window

Q.5 WHAT IF I HAVE MORNING SICKNESS?

If you experience morning sickness or any other vomiting in pregnancy you may need to alter the times you take your AEDs. If you need advice about this or the vomiting continues, contact your GP urgently as vomiting can affect the absorption of your AEDs, which can cause a recurrence of seizures.

Q.6 CAN A SEIZURE HARM ME OR MY BABY DURING PREGNANCY?

There is a small increased risk of harm to a woman and her unborn during a tonic clonic seizure, especially if the seizure is prolonged. To protect yourself, ensure family/friends are aware of appropriate first aid.   Seek urgent help from your healthcare team if you have recurrence of seizures in pregnancy. Visit Epilepsy Society for advice on first aid for convulsive seizures.

Q.7 HOW CAN I REDUCE THE RISK OF PREGNANCY COMPLICATIONS?

• Have a preconception epilepsy specialist review so that your epilepsy is optimally controlled before pregnancy.  
• Quit smoking and avoid being overweight
• Attend appointments and advised screening tests and request that all healthcare professionals record the consultation in your handheld notes.
• Take your own AEDs as prescribed throughout pregnancy and during any hospital admission, including labour.
• Avoid admission to an unattended single room whilst in hospital care.
• Keep in contact with your midwife so that any changes in your physical or mental health can be treated promptly. Inform your midwife if getting to appointments is difficult so that she can make alternative arrangements. 
• Use appointments as an opportunity to inform professionals about your epilepsy
•  Conduct a self-risk assessment for your safety and in preparation of your hospital admission for labour. This includes safety around water. Feel in control of your pregnancy and epilepsy by making informed choices and plans about your shared care.
• For further information about epilepsy before, during and after pregnancy, visit Epilepsy Action
• Visit Epilepsy Society for further information about giving birth and epilepsy opens in a new tab/window  and  breastfeeding and epilepsy opens in a new tab/window