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Planning for pregnancy

mother playing with her baby.

Before becoming pregnant

Before becoming pregnant, it is best to seek pre-conceptual counselling from your doctor or epilepsy specialist nurse. If your pregnancy is planned carefully then any risk of complications may be minimised.  You should be seen by an epilepsy expert to discuss your treatment well in advance of pregnancy. The primary aim in doing this is for seizure freedom before conception (where possible) and during pregnancy (particularly for women and girls with generalised tonic clonic seizures), while also considering the risk of possible ill effects of anti seizure medication (AED) and using the lowest effective dose of each AED, avoiding multiple medications if possible.

It is advisable for some women on certain AEDs to have an anti-seizure medication drug level taken prior to becoming pregnant. This is measured by a blood sample and it is used as a reference should you run into any problems whilst pregnant. This level should be taken early in the morning by your GP or neurology service prior to your first morning dose of medication. Routine monitoring of AED levels in pregnancy is not recommended unless you are taking the medications Lamotrigine (Lamictal) and/or Levetiracetam (Keppra). If you are on another AED, and seizures increase, monitoring of this other AED may be useful to plan future changes to your seizure medication. The potential risks and benefits of adjusting treatment, if necessary, can be discussed.

Advice on diet, smoking, alcohol, avoiding infection, etc. will be the same for any woman planning pregnancy. However, other things may be pertinent for women with epilepsy, including:

  • In some cases it may be wise to change to a different medication which is less likely to cause harm to a developing baby (depending on the medication you are already taking).  
  • It may be an option to stop or reduce the dose of your treatment before you become pregnant if your seizures have been well controlled. However, deciding to come off antiepileptic medication can be a difficult decision. Factors such as the type of epilepsy that you have can be important. For example, if you have the type that causes severe tonic clonic seizures, there is a risk that you could have a severe seizure when you are pregnant if you stop your medication.
  • You are advised to take 5mg folic acid a day. This should ideally be taken at least 3 months before you become pregnant and continued until you are 14 weeks pregnant. Although folic acid is recommended for all women who are pregnant, the dose for women taking antiepileptic medicines is higher than usual. Taking folic acid has been shown to reduce the risk of having a baby born with a spinal cord problem such as spina bifida. 

Under no circumstances should you stop taking your antiepileptic medication without seeking specialist advice first.