Epilepsy and pregnancy. What are the nuances of treating epilepsy during pregnancy? Dr. Anton Titov, MD. What are the major risks for mother and for a child? Because there is a risk of epileptic seizures. Dr. Tracey Milligan, MD. There is also risk of the side effects of anti-epileptic medications. Yes, epilepsy and pregnancy is a very important topic. Dr. Tracey Milligan, MD. I always like to start by emphasizing that women with epilepsy will have wonderful pregnancies and beautiful healthy babies. The vast majority of pregnancy women with epilepsy will have a healthy pregnancy course and a healthy baby. That is something that not everybody knows. Sometimes patients think that women with epilepsy can't have children. They think that women with epilepsy shouldn't have children or will have problems. That is not true in over 90% of pregnancies. Dr. Tracey Milligan, MD. It is very important that a woman with epilepsy work with a doctor. She must get good epileptic seizure control before pregnancy. Because how well the epileptic seizures are controlled before pregnancy predicts how perfectly epileptic seizures will be controlled during pregnancy. The body's metabolism really changes during pregnancy. That is why we want to know the true level of anti-epilepsy medications. Dr. Anton Titov, MD. What is the amount of anti-epilepsy medication in the bloodstream prior to the pregnancy? Dr. Tracey Milligan, MD. We work to keep that anti-epilepsy medication at the same level. I also want to emphasize how important it is to take anti-epileptic medications during pregnancy. Dr. Anton Titov, MD. That is so important. Many women are afraid that the epilepsy medication will hurt the baby. So they stop the epilepsy medication and that causes problems for the mother and for the baby. Dr. Tracey Milligan, MD. In women with epilepsy, they should continue to take epilepsy medication all through pregnancy. They have to maintain control of the epileptic seizures. Seizures are worse for the baby than the epilepsy medication. There are some anti-epileptic medications that we think are relatively safe during pregnancy. Dr. Tracey Milligan, MD. There are other epilepsy medications, for example, Divalproex Sodium, that we know are harmful to the baby. There are anti-epileptic medications that we try to avoid in a woman who could become pregnant. These medications are a divalproex sodium, phenobarbital and topiramate. Those three anti-epileptic medications we know have a higher risk of birth defects. Some of the newer anti-epileptic medications seem to be fairly safe. Dr. Tracey Milligan, MD. We have good clinical trials that show good safety. Such newer medications seem to be fairly safe during pregnancy. But the bottom line is this. A woman who is thinking about becoming pregnant should first talk to their doctor. She should discuss the epilepsy medication that she is taking. A woman may not be thinking about being pregnant. But their doctor should talk to them. Because many pregnancies are not planned. That is why we also recommend an important preventive step. Dr. Tracey Milligan, MD. All women with epilepsy who could become pregnant must take folic acid. Folic acid is a vitamin that is known to reduce the risk of birth defects. Dr. Anton Titov, MD. Folate is the other name for folic acid. In the United States, for example, we started adding folate to our grain products. Then there was a dramatic decrease in neural tube defects among all women in the United States. Women with epilepsy might have a greater risk of having a lower level of folic acid. Dr. Tracey Milligan, MD. We recommend women take one milligram of folic acid every day. Even if they are not planning to become pregnant. Because many pregnancies are unplanned. When the woman is aware that she's pregnant, the neural tube has already formed. Neural tube will become the spinal cord and the brain. During pregnancy, we will make sure that the true level of medications stays the same in their system. Dr. Tracey Milligan, MD. That usually requires increasing the dose of epilepsy medication. The dose of anti-epilepsy medication may increase quite a bit. The number of pills a woman takes during pregnancy may increase. Dr. Tracey Milligan, MD. But that anti-epilepsy medication level in the blood will stay steady. It just requires more pills to keep that level steady. We also encourage women to breastfeed their infants after birth. We know that breastfeeding has a number of benefits. Those benefits outweigh the risk of the medication in the breast milk. Most women have very healthy pregnancies. They give birth to healthy babies. But there is a little increased risk in women with epilepsy. Dr. Tracey Milligan, MD. Because we do know that there's an increased risk during childbirth. It is important to seek the care of a trained obstetrician. It is crucial to have an obstetrician involved in the childbirth. Dr. Anton Titov, MD. Is there a particular reason to have a cesarean section delivery in a woman with epilepsy? There is no reason for a woman with epilepsy to have a cesarean section simply because she has epilepsy. But there is a need for increased monitoring of woman and fetus during childbirth. Dr. Tracey Milligan, MD. There has to be an awareness that more complications could happen during the delivery. A pregnant woman must have a trained physician present and ready to perform a Cesaren section operation, if necessary. But it is not because the woman has epilepsy.