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Seizure Disorders During Pregnancy

by Lara A. Friel, MD, PhD

Most women who have a seizure disorder are able to safely give birth to a healthy baby. However, women who have seizures are slightly more likely to

  • Develop preeclampsia (a type of high blood pressure that develops during pregnancy—see Preeclampsia and Eclampsia)

  • Have a stillbirth

  • Have a fetus who does not grow as much as expected

On the other hand, taking anticonvulsants increases the risk of birth defects (see Table: Some Drugs That Can Cause Problems During Pregnancy *) and may slightly reduce intelligence in the baby. However, these risks may be increased by the seizure disorder as well as by the use of anticonvulsants.

Taking certain anticonvulsants (such as phenytoin, carbamazepine, or phenobarbital) during pregnancy increases the risk of hemorrhagic disease of the newborn (which causes a tendency to bleed easily). However, if women take prenatal vitamins with vitamin D and if vitamin K is given to the newborn, hemorrhagic disease rarely occurs.

Thus, women who have a seizure disorder should discuss how to balance the risks with an expert in the field, preferably before they become pregnant. Some women may be able to safely stop taking anticonvulsants during pregnancy, but most women should continue to take the drugs. The risk resulting from not taking the drugs—more frequent seizures, which can harm the fetus and the woman—usually outweighs the risks resulting from taking the drugs during pregnancy.

Doctors prescribe the lowest effective dose of the anticonvulsants and use as few different anticonvulsants as possible. Women who take anticonvulsants need to take a high dose of a folate supplement. Ideally, it is started before they become pregnant.

Vaginal delivery is usually possible. Cesarean delivery is done only if women have repeated seizures during labor or other problems develop and require it.

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