The American Academy of Neurology, American Epilepsy Society, and Society for Maternal-Fetal Medicine review the latest evidence on epilepsy and pregnancy and make recommendations to help you and your doctors decide how to best manage your condition before and during pregnancy.

What the research says about how epilepsy, and epilepsy medications, can affect pregnancy

Most babies born to people with epilepsy are healthy, according to the latest research. However, there is a small risk of pregnancy-related problems, partly due to seizures and partly due to the effects of antiseizure medications. These risks can be minimized by discussing your medications with your doctors and notifying them as soon as possible if you are pregnant or plan to become pregnant.

Certain medications may be better than others

There are different risks with different medications and a few are preferred in pregnancy due to their relative safety. Some drugs such as valproic acid, topiramate, and phenobarbital may increase the chance of birth defects or of a child having autism or a lower IQ. If you are taking one of these medications and plan to become pregnant, ask your doctor if there are better options for controlling your seizures. Taking folic acid supplements during pregnancy may help reduce the risk of neural tube defects. It also may possibly reduce the incidence of autism spectrum disorder and likely improve global IQ. More research is required to better understand the risks, especially among newer medications, such as eslicarbazepine, lacosamide, and perampanel. The appropriate medication depends on several factors, including how effectively it controls seizures, potential risks during pregnancy, other possible side effects, and personal preferences. It’s important to not stop or change your antiseizure medications until talking with your doctor about your concerns.

Questions to ask your doctor

• I’m thinking about becoming pregnant—what do I need to know about my antiseizure medications?
• Am I taking the best combination of medications to control my seizures and reduce any risks for my unborn child?
• Do I need to take folic acid if I am pregnant or planning a pregnancy?
• What screening tests should I undergo during pregnancy to alert me and my medical team of any problems with my unborn child’s physical development?
• What screening tests should my infant undergo after birth to alert us to any extra needs they may have as they grow?

Key takeaways

• Most children born to people with epilepsy are healthy.
• In general, there is a small risk of pregnancy-related problems, partly due to seizures and partly due to the effects of their antiseizure medications.
• Discuss your plans for pregnancy with your doctor before conceiving.
• Notify your doctor as early as possible if you discover you are pregnant.
• If you become pregnant, don’t stop or change your antiseizure medications. Talk with your doctor about any concerns you have about your medications.
• Ask your doctor whether you should take folic acid before and during pregnancy to limit the risk of birth defects and developmental problems.

The recommendations in this clinical practice guideline, which is endorsed by the Child Neurology Society, are based on existing research that studied outcomes among children of people with epilepsy who took antiseizure medications during pregnancy. The guideline is designed to help people with epilepsy who could become pregnant, and their doctors, choose the best antiseizure medications and doses for them. You can read the full guideline for free in Neurology.