Pregnancy Risks

Regular visits to both the obstetrician and the neurologist are crucial for women with epilepsy.

Risks of Epilepsy in the Baby

Children whose parents have epilepsy have a slightly higher risk of developing epilepsy. The lifetime risk of developing epilepsy in the general population is approximately 3%. If the father has epilepsy and the mother does not, the risk to the children is only slightly higher than 3%. If the mother has epilepsy and the father does not, the risk is somewhat higher but still under 5%. The highest risk is in women with primary generalized epilepsy. If both parents have epilepsy, the risk is a bit higher than if only one parent has the condition.

A couple in which one or even both partners have epilepsy should not decide against having children because of fear that the children will have epilepsy. The risk of epilepsy in their children is still quite low, many children outgrow epilepsy, and as the parents surely know, most people with epilepsy are seizure-free with medication, and lead perfectly normal lives.

Birth Defects and Antiepileptic Drugs

Can antiepileptic drugs increase a child's chance of being born with a major birth defect?

The healthiest women have a 2-3% chance of having a baby with a major birth defect. The chance increases to between 4-6% in women with epilepsy. The reasons for this increase are not fully understood. We know that the risk is heightened by the use of antiepileptic drugs. Genetic factors definitely contribute to an increased risk of birth defects in the general population. It remains uncertain, however, whether genetic factors increase the risk that women or men with epilepsy will have children with birth defects. A few studies suggest that certain birth defects are slightly more common among children of parents who have epilepsy, even if the parents did not take antiepileptic drugs. If there is a family history of birth defects, then the parents should seek genetic counseling.

Antiepileptic drugs taken by the mother shortly before conception and during the first 3 months of pregnancy clearly present the greatest danger to the developing baby; although not taking medications could be associated with uncontrolled seizures and an increased risk of miscarriage. The danger of antiepileptic drugs taken by the father is less clear. Some studies show a slight increase in birth defects among babies whose fathers took antiepileptic drugs, but others show no increase.

How is the developing child affected by AED's?

The first trimester (first 3 months) of pregnancy, especially days 21 to 56, is the critical period for development of the baby's major organ systems. The second and third trimesters (the last 6 months) are critical for its growth and maturation. In a relatively small number of cases, exposure to antiepileptic drugs during the first trimester can cause major birth defects such as cleft lip and cleft palate (a gap in the middle of the lip or palate) and structural defects of the heart. Other major malformations affect the central nervous system, the gastrointestinal system, the reproductive system, the urinary system, and the skeletal system. These defects are serious but often the child can live normally after surgical correction or other forms of treatment. Minor malformations may result from exposure to antiepileptic drugs during the last 6 months. These include widely spaced eyes, a small and upturned nose, and short fingers and toes. Minor defects are actually not rare in the general population and may disappear after the first year of life.

The newer antiepileptic drugs (felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, and zonisamide) have not been adequately studied in pregnant women, and their safety remains uncertain, though preliminary reports are encouraging. Information about their safety will eventually come from the North American registry for women taking antiepileptic drugs during pregnancy. Pregnant women who are taking antiepileptic drugs are strongly urged to contact the registry (888-233-2334, or ) and provide information that may help define the safety of their future pregnancies, as well as the pregnancies of other women with epilepsy. Communication with the registry is confidential.

How can a woman planning on becoming pregnant reduce the risk of birth defects in her child?

  • Treatment with one antiepileptic drug in the lowest dosage that will control the seizures presents the least risk for the baby's development. Any woman of childbearing age who is taking two or more antiepileptic drugs, and who would like to consider pregnancy or having the baby if she became pregnant, should ask her doctor if she could be treated with one medication. More than one drug may be necessary for some women because of the difficult nature of their seizure disorder, but many women can be safely treated with one drug, and some can remain seizure-free with lower dosages than usually taken. Women who are thinking of discontinuing their antiepileptic drugs may find no better time to try it, under a doctor's supervision, than before pregnancy.
  • A woman of childbearing age with epilepsy should take a folic acid supplement. Folate deficiency has been associated with spinal abnormalities such as spina bifida. Some antiepileptic medications interfere with folate metabolism and diminish the amount of folate in a woman's body. Therefore, all women of child-bearing potential should take a folic acid supplement, whether planning for pregnancy or not, to reduce the risk of a spine problem in the baby should pregnancy occur. Women should check with their doctor about the amount of folic acid they should take.
  • All women with epilepsy planning for pregnancy should avoid caffeine, tobacco, and alcohol, just as women without epilepsy should do.
  • In a woman with epilepsy, adequate sleep and good nutrition are likely even more important through all stages of the reproductive cycle, but particularly during conception and pregnancy, than if she did not have epilepsy. Breakthrough seizures, associated with a woman not taking the best possible care of herself during this period, also contribute to an increased risk of birth defects in her child.
  • Although not a birth defect per se, babies born to women with epilepsy have an increased risk of suffering from internal bleeding if the mother is taking certain medications. These medications are the enzyme-inducing antiepileptic drugs (carbamazepine, phenobarbital, phenytoin, primidone, oxcarbazepine, felbamate and topiramate). Women taking any of these medicines are routinely prescribed 10 to 20 mg per day of vitamin K by mouth during the last 4 weeks of pregnancy, to prevent the possibility of internal bleeding in the newborn. Although intramuscular vitamin K is given to most babies at delivery, use of oral vitamin K by the mother is still generally recommended.