Mother and Baby

Hergoz AG, MacEachern DB, Mandle HB et al. Epilepsy & Behavior 72(2017):156-160

All women have a low risk of having a child with a major birth defect. Women with epilepsy taking certain seizure medications may have a higher risk of having a child with a major birth defect.

Planning pregnancies in advance and using folic acid prior to and during pregnancy is thought to lessen the risk of major birth defects. Taking folic acid preventively is especially important in women taking certain seizure medicines and hormonal contraceptives. The risk for unintended pregnancy is higher with some seizure medications that interfere with hormonal birth control, thus increasing a woman’s risk for unplanned pregnancy.


The Epilepsy Birth Control Registry (EBCR) is a web-based survey and educational resource about contraception for women with epilepsy. This study looked at the how many women of childbearing age used folic acid and their risk of pregnancy.

Description of Study

Participants completed a survey on the EBCR website that included information about contraception, pregnancy, folic acid use, seizure medications, and seizures.

  • 1,144 women with epilepsy participated between 2010 and 2014
  • Age range of participants was 18-47 years old
  • 69.8% of participants were at risk for having an unintended pregnancy

Summary of Study Findings

  • Only 47.8% of women with epilepsy who were at risk for unintended pregnancy were taking folic acid.
  • The use of folic acid was greater in women who wanted to become pregnant or were pregnant.
  • Other factors that were related to folic acid use were race, income level, and education level.
  • Seeing a health care provider in the year before completing the survey was not related to use of folic acid. However, women who saw a gynecologist in the preceding year were more likely to be taking folic acid than those who saw a neurologist, primary care provider, or nurse practitioner.

What does this mean?

  • In 2007, the CDC found that only 40% of women in the general population were following recommendations to use folic acid prior to pregnancy.
  • This study showed that women with epilepsy are not doing much better. Only 46.7% were using folic acid, yet some of these women taking anti-seizure medicines are at greater risk of having a child with a major birth defect.
  • Educational efforts to ensure that all women with epilepsy taking seizure medicines are also using folic acid is critical. The lower rates of folic acid use in women from some minority groups or with low income highlights the need to expand these messages to reach every woman with seizures or epilepsy.
  • A woman’s risk for having a child with a major birth defect, while small, can vary depending on the seizure medicine taken. We encourage all women to talk to all their health care providers to learn their risks and what dose of folic acid they should take.

Article published in Epilepsy & Behavior, July 2017.

Authored By: 
Patty Obsorne Shafer RN, MN
Authored Date: 
Reviewed By: 
Joseph I. Sirven MD
Monday, July 24, 2017