The Epilepsy and Pregnancy program focuses on understanding the unique care needs of women with epilepsy. We understand how those needs intersect with their reproductive health choices and address concerns related to contraception, fertility, conception, pregnancy, childbirth, and the postpartum period.
Our program is one of just a few specialized women's programs in the nation and the only one of its kind in Pennsylvania. As part of the Women's Neurology Division at UPMC, we are dedicated to providing comprehensive care for women with epilepsy to meet their unique needs at every stage.
When you have epilepsy, reproductive choices like pregnancy can be challenging. Pre-pregnancy planning is the best way to increase your odds of a healthy journey for you and your baby.
Our team of neurologists has several years of specialty training in epilepsy care for people who are planning to become pregnant. These experts follow each individual with epilepsy through their pregnancy, delivery, and into the postpartum period.
This care continuum includes:
People with epilepsy can have healthy pregnancies and deliver healthy babies with some planning.
Epilepsy and pregnancy care is for people who:
Ideally, doctors like to see people with epilepsy about one year before they start trying to conceive.
Preconception planning can help if you need to make changes to your medications. Some ASMs are not safe to use during pregnancy. Switching to a safer ASM can take several months.
Your neurologist may also put you on 1 mg of folic acid before you try to conceive to prevent birth defects and help with fetal brain development.
People with epilepsy get pregnant at the same rate as people who don't have epilepsy. In addition, ASMs do not affect fertility. More than 40% of all pregnancies are unplanned, according to the U.S. Centers for Disease Control and Prevention.
That means that if you do not want to become pregnant, you will need to use a form of birth control. Your neurologist can work with your primary care provider or ob-gyn to make recommendations based on your lifestyle, ASMs, and other concerns.
Conversely, if you have been trying to get pregnant and have not succeeded within a year, you may need help getting pregnant, just like someone without epilepsy.
UPMC Magee-Womens offers assisted reproductive technologies to help with a variety of fertility issues.
If you become pregnant while you are on ASMs — don't panic. Let your neurologist know as soon as possible. They can work with you to adjust your medication accordingly.
Research shows that if you were seizure-free the nine months before becoming pregnant, your likelihood of experiencing seizures during pregnancy does not increase. The key factor is managing your seizures with the proper amount of medication.
Nearly a third of people with epilepsy cannot achieve complete control of their seizures through ASMs, according to the Epilepsy Foundation. If you are one of them, your neurologist will work closely with you to prevent more frequent or more serious seizures during your pregnancy. Studies show seizures are not necessarily more likely during pregnancy — as long as you get proper care.
Visits to your neurologist are essential during pregnancy for several reasons:
Dramatically changing hormone levels during pregnancy can cause your body to clear your ASMs more quickly. It is essential to measure your blood levels throughout your pregnancy. Your neurologist will usually want to check your ASM levels monthly via blood work, which can be done at an outpatient lab.
According to a 2022 review in the journal Therapeutic Advances in Neurological Disorders, doctors will often raise ASM doses by 25% to 50% during the first month of pregnancy.
Your neurologist likely will not have you switch ASMs unless you take valproic acid. This drug has a higher risk of birth defects and developmental issues. Your doctor will decide if you can safely lower your dose without the risk of seizures or if switching to a lower-risk ASM is a better option.
Your doctor will want you to get bloodwork done a few days up to a week before each visit so they can discuss the results with you at your appointment. They may ask you for a "trough-level" ASM blood measurement.
To get a trough-level blood measurement, get your blood drawn one hour before you usually take your antiseizure medication. For example, if you take your ASM at 8 a.m. and 8 p.m., try to get your bloodwork done at 7 a.m.
If you can't get a trough level, that's OK – just don't skip your bloodwork.
Some people have trouble with nausea during pregnancy. Although called "morning sickness," nausea can affect you any time of day. For those with epilepsy, it's vital to make sure the ASMs you take stay down to keep you seizure-free.
If you're struggling with nausea and vomiting, tell your neurologist so they can provide coping strategies or medication to control it.
Because you have epilepsy and are pregnant, your neurologist may refer you to a maternal-fetal medicine (MFM) specialist for an initial evaluation. MFMs are obstetricians with special training in pregnant people with chronic health conditions.
The MFM will likely continue to provide your care throughout the rest of your pregnancy. Your neurologist and MFM will work together to help you stay seizure-free while ensuring your baby is growing well.
Fortunately, the onset of labor does not put people with epilepsy at higher risk of seizure.
In addition, having epilepsy does not put a person at higher risk of needing a C-section or other intervention during delivery. People with epilepsy give birth vaginally at the same rate as people who don't have epilepsy, according to the Epilepsy and Pregnancy Medical Consortium.
To ensure that you stay seizure-free during your labor and delivery, take a few steps to prep:
If your doctor increases your antiseizure medication during pregnancy, it's important to taper back the dosage quickly after delivery. Talk to your neurologist about the correct dosage to take after delivery.
Your neurologist can also counsel you on how to care for your newborn, with tips for your baby's safety in case of a seizure, such as:
When you're pregnant and have epilepsy, you want the best care for yourself and your baby. Choose UPMC for epilepsy and pregnancy care.
We take a team approach to your care. At UPMC, our team of experts includes:
