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Seizure Disorders During Pregnancy

By

Lara A. Friel

, MD, PhD, University of Texas Health Medical School at Houston, McGovern Medical School

Last full review/revision Oct 2021
CLICK HERE FOR THE PROFESSONAL VERSION

Most women who have a seizure disorder Seizure Disorders In seizure disorders, the brain's electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction. Many people have unusual sensations just before a seizure... read more that is well-controlled by antiseizure drugs are able to safely give birth to a healthy baby. If these women get enough sleep and take antiseizure drugs 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 antiseizure drugs increases the risk of birth defects (see table Some Drugs That Can Cause Problems During Pregnancy Some Drugs That Can Cause Problems During Pregnancy* More than 50% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy... read more ) 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 antiseizure drugs.

Taking certain antiseizure drugs Antiseizure drugs In seizure disorders, the brain's electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction. Many people have unusual sensations just before a seizure... read more (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 antiseizure drugs with the risks of having seizures, preferably before they become pregnant. Some women may be able to safely stop taking antiseizure drugs 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 antiseizure drugs during pregnancy.

Doctors prescribe the lowest effective dose of the antiseizure drugs and use as few different antiseizure drugs as possible. Women who take antiseizure drugs need to take a high dose of a folic acid supplement daily. Ideally, it is started before they become pregnant. Taking folic acid supplements helps reduce the risk of having a baby with a birth defect.

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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Postpartum Depression
Postpartum depression is a feeling of extreme sadness and related psychologic disturbances after delivery of a baby. Although it is common to feel sad or miserable within 3 days of delivery (the baby blues), these feelings usually go away within 2 weeks. Postpartum depression is a more serious mood change. Women in which of the following groups are at increased risk for this condition?
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