Women and Epilepsy: Preconception, Pregnancy, and Breastfeeding

Epilepsy is a chronic neurological disorder that causes recurrent seizures. It affects millions of people worldwide and can have a significant impact on daily life, mental health, and overall wellbeing.

For women, epilepsy can pose unique challenges due to hormonal changes during menstruation, pregnancy, and menopause. These hormonal shifts may affect seizure frequency and how well anti-seizure medications (ASMs) work. That’s why personalized care is especially important when planning for pregnancy or navigating motherhood.

Preconception

Planning ahead is key. If you're living with epilepsy and thinking about starting a family, a preconception consultation with your neurologist is essential. This visit allows your care team to:

• Optimize seizure control
• Discuss your reproductive health and pregnancy journey
• Provide counselling and support
• Minimize risks to both mother and baby

How does epilepsy affect fertility?

Epilepsy itself typically does not impact fertility, and conception rates are generally similar between women with and without epilepsy. However, certain anti-seizure medications (ASMs) may affect hormone levels, which can lead to irregular menstrual cycles or ovulation issues. These concerns can be addressed during your preconception evaluation, with input from your neurologist and, if needed, a fertility specialist.

Can anti-seizure medications impact conception?

Yes. Your care team will help you prepare for a safe and healthy pregnancy by:

• Reviewing and adjusting your medications
• Recommending lifestyle changes
• Starting folic acid supplements to reduce the risk of birth defects

The goal is to achieve seizure control on the safest possible medication plan before you conceive.

Pregnancy

What are the risks of pregnancy for women with epilepsy?

Pregnancy can increase seizure frequency due to hormonal changes and altered medication metabolism. There are also higher risks of complications like pre-eclampsia and gestational hypertension. Your neurologist will carefully monitor your condition and many women with epilepsy have successful pregnancies.

How do my medications affect pregnancy risk and hormonal contraception?

Certain ASMs, in particular enzyme-inducing drugs, can decrease the effectiveness of hormonal contraceptives. Additionally, some medications can increase pregnancy-related complications. Your neurologist will carefully tailor your medication to minimize any risk.

Can seizures control be maintained before pregnancy?

During a preconception consultation, your neurology team will review your medication, suggest lifestyle adjustments, and advise taking folic acid supplements (to reduce the risk of neural tube defects). Your medical team will also adjust ASM doses to ensure optimal seizure control before conception.

Can anti-seizure medications affect the baby?

Yes. Some ASMs carry a risk of teratogenicity, which means they can increase the risk of certain complications. Potential risks may include:

• Birth defects
• Low birth weight
• Developmental delays

Your doctor will work closely with you to balance seizure control with the lowest possible risk to your baby.

What are the risks of pregnancy for women with epilepsy?

Studies show that seizure frequency is generally similar in pregnant and non-pregnant women. However, hormone changes and shifting medication levels during pregnancy and postpartum may require frequent dose adjustments. Without close monitoring, this could increase seizure risk.

Women with epilepsy are also at slightly higher risk for:

• Pre-eclampsia
• Gestational hypertension
• Premature delivery

With the right care, most women with epilepsy go on to have healthy pregnancies and babies.

How do epilepsy medications affect contraception and pregnancy?

Some ASMs, particularly enzyme-inducing medications, can lower the effectiveness of hormonal birth control. Additionally, certain contraceptives can reduce the levels of specific ASMs, increasing the risk of seizures. A multidisciplinary approach involving both a neurologist and a gynaecologist can help manage these interactions effectively.

Breastfeeding

Can I take anti-seizure medications while breastfeeding?

Many ASMs are considered safe while breastfeeding, though small amounts may pass into breast milk. Your doctor will review your medications and discuss any potential risks, so you can make an informed decision.

How can I safely manage epilepsy while breastfeeding?

To minimize your baby’s exposure to medication, it is recommended to take your anti-seizure medication immediately after breastfeeding. You should also monitor your baby for any signs of drowsiness or feeding difficulties. Breastfeeding is often encouraged, and with proper support and medical guidance, most women can safely continue their ASM regimen while nursing.

How We Can Help

At Cleveland Clinic Abu Dhabi, our Women’s Epilepsy Clinic provides compassionate, expert care tailored to women with epilepsy across all stages of life, from preconception through pregnancy and postpartum.

Whether you're planning to become pregnant or navigating new motherhood, we’re here to guide you every step of the way.

If you have questions or need support, reach out to our team. Your health—and your baby’s—is our top priority.