Planning & Pregnancy
Pregnancy and Anti-Seizure Medications
Many people with epilepsy have healthy pregnancies. Planning with your healthcare team helps balance seizure control with the potential effects of medication on a developing baby.
About this information
Epilepsy Ontario regularly reviews this educational material. It does not replace professional medical advice, diagnosis or treatment. Discuss your own medication, pregnancy and care with your healthcare team.
Do not stop or change prescribed medication independently.
A Clear First Step
Pregnant or think you might be?
Contact your epilepsy healthcare team promptly for a medication review. Continue following your prescription unless a clinician gives you different instructions.
Suddenly stopping treatment can lead to serious seizures. A medicine that controls convulsive seizures should not be removed or replaced without careful clinical assessment.
Before Pregnancy
Review treatment early.
Your medication
Ask about the evidence for your specific medicine and dose. When a change is appropriate, planning before conception allows time to assess seizure control and tolerability.
Your seizure pattern
Discuss recent seizures and your treatment history. Preventing convulsive seizures during pregnancy is an important part of protecting both you and the baby.
Folic acid
Folic acid supplementation is recommended before conception and during pregnancy for people taking anti-seizure medication. Ask your healthcare provider which dose is appropriate and when to begin.
Contraception
Ask whether your medication affects your contraceptive method or whether contraception affects your medication. Your team can help you choose a suitable plan.
Risk differs between medicines.
There is no single pregnancy-risk percentage that applies to every anti-seizure medication. The particular medicine, dose and treatment combination matter.
Valproate has important risks for birth defects and a child’s development. Topiramate also has pregnancy-related risks. Anyone taking these medicines who could become pregnant should discuss their treatment with their specialist.
These concerns are a reason for a planned review, not a reason to stop treatment yourself. The team must also consider the risks of uncontrolled seizures.
During Pregnancy
Keep your care team informed.
Monitoring medication
Pregnancy can change medication levels. Your clinician may arrange blood tests or adjust treatment according to the medicine, test results and seizure control.
Changes in seizures
Tell your healthcare team about new or worsening seizures. Keep a seizure record and follow the monitoring plan agreed for your pregnancy.
Questions for your appointment
- What is known about my medication during pregnancy?
- Would a treatment change be appropriate before conception?
- Which folic acid dose should I take?
- Will I need medication-level monitoring?
- Who should I contact about changes in seizures or treatment?
Research & Participation
North American Pregnancy Registry
The North American Antiepileptic Drug Pregnancy Registry collects information about medication exposure and pregnancy outcomes. It includes participants in Canada and the United States.
Participation is voluntary. Check the registry’s current eligibility and enrolment information directly.
Further reading:
AAN, AES and SMFM pregnancy guideline
·
North American Pregnancy Registry.
