Epilepsy brings special issues for women, particularly in pregnancy. As the French say, vive la difference. And while equality between the sexes is a goal that most people applaud, the French do have a point.

Epilepsy affects women differently. Their hormonal and menstrual cycles, pregnancy, menopause—all of those life stages are affected by epilepsy. The treatment of their epilepsy may be affected by their hormonal state or their epilepsy and it's treatment could affect their hormones. 

While the majority of women with epilepsy can and do become pregnant, they may have certain risks that women without epilepsy don't have. These risks can affect their health and that of their babies. Yet if properly managed, the risks are very small. In fact over 90% of women with epilepsy who become pregnant have healthy babies. 

When women with epilepsy have problems, they are often hormone-based.  Two specific hormones are especially important: estrogen, which increases the electrical activity of the brain, and progesterone, which has the reverse effects.

Some general points about pregnancy and epilepsy

  • Planned pregnancies are usually best for women with epilepsy. This gives you time to work with your neurology/epilepsy team and obstetrical team ahead of time. 
  • About half of all pregnancies in the U.S. are unplanned! So, please talk to your health care team about pregnancy early, even when you are not planning to have a child. 
  • Get a health care team willing to work together with you - before, during and after the pregnancy. Ideally, see a neurologist who specializes in epilepsy and an obstretician comfortable with epilepsy. Most importantly, you want both doctors to work well together and with you. Add a nurse and social worker or other mental health counselor to your team. You'll likely have many practical questions about pregnancy, safety and parenting to address. It can be an emotional time too and having support is crucial!
  • Review your seizure medications and seizure control with your epilepsy team before you become pregnant.
  • Make sure you are taking prenatal vitamins and folic acid. 
  • Plan for frequent visits to your neurology team during pregnancy. Levels of seizure medications will need to be monitored regularly and changes in doses may be needed. 
  • Pay attention to healthy living and seizure triggers. Some women are more likely to have seizures during pregnancy due to hormonal changes, fluctuating medicine levels, or other factors. 
  • Breastfeeding is possible and recommended for most women with epilepsy. You'll want to talk about this early with your epilepsy and OB team. 
  • Having children is a big responsibility and you'll likely have many questions or concerns about parenting and how epilepsy may or may not affect this.
  • Don't forget that this is a family affair. Involve your spouse, partner, and key family and friend supports as early as possible!  

 

Reviewed by: Joseph I. Sirven, MD | Patricia O. Shafer, RN, MN | Kimford J. Meador MD on 3/2014
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