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Seizure Disorders During Pregnancy

By Lara A. Friel, MD, PhD, Associate Professor, Maternal-Fetal Medicine Division, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Medical School at Houston, McGovern Medical School

(See also Seizure Disorders.)

Most women who have a seizure disorder that is well-controlled by anticonvulsants are able to safely give birth to a healthy baby. If these women get enough sleep and take anticonvulsants in appropriate doses, the number of seizures usually does not increase during pregnancy, and pregnancy outcomes are usually good. However, these women are slightly more likely to

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 talk to an expert in the field about how to balance the risks of taking anticonvulsants with the risks of having seizures, 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 anticonvulsants 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 daily. 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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