Young women with epilepsy who are pregnant or planning a pregnancy need to make informed decisions about their anti-seizure medications.
This section covers conception, pregnancy planning and pregnancy, breastfeeding and medications monitoring.
Regularly reviewed information for young women
As a young woman with epilepsy, you should have regularly reviewed information, tailored to your age and needs, about:
- Contraception
- Pregnancy
- Folic acid supplementation
- Conception
- Breastfeeding
- Caring for children
- Menopause
Anti-seizure medications and contraception
Hormonal contraceptives can be made less effective by some anti-seizure medications, including:
- Carbamazepine (Tegretol and other brand names)
- Oxcarbazepine (Trileptal and other brand names)
- Phenytoin (Dilantin and other brand names)
- Topiramate (Topamax and other brand names)
Also, contraceptives containing the hormone oestrogen and hormone replacement therapy can make the anti-seizure medication lamotrigine (Lamictal and other brand names) less effective.
Pregnancy and pregnancy planning
If you’re a young woman with epilepsy planning a pregnancy, or are already pregnant, you should be referred to an epilepsy specialist team for a review of your anti-seizure medication options.
Information about your care will be shared between the epilepsy specialist team, a specialist obstetric team and primary care (your GP).
If you’re pregnant or planning a pregnancy, it’s important that you keep taking your anti-seizure medication as normal, and don’t stop without medical advice.
The epilepsy specialist team should discuss with you the benefits and risks of adjusting medication so you can make informed decisions.
Discussion should cover the balance between the risks of poorly controlled seizures and the risks to your baby when taking certain anti-seizure medicines while pregnant or breastfeeding.
Anti-seizure medications and pregnancy
Your epilepsy specialists should discuss with you the risks of taking certain anti-seizure medications during pregnancy if:
- You’re a woman with epilepsy who can have children
- You’re a girl who has started periods
- You’re a young girl likely to need treatment for epilepsy when you can have children
This should also be discussed with parents or carers, as appropriate.
The risks to an unborn child of taking anti-seizure medications during pregnancy can include:
- Congenital malformations – physical defects present from birth
- Neurodevelopmental impairments – disorders affecting the brain and/or central nervous system
- Foetal growth restriction – the unborn baby is smaller than expected for the number of weeks of pregnancy
Your epilepsy specialists should assess the risks and benefits of treatment with specific anti-seizure medications.
It's very important that you continue to take anti-seizure medication as prescribed. This protects against the harm that seizures can cause.
Your epilepsy specialist should know about the uncertainties and risks, particularly with newer drugs. They should also follow the latest guidance from the Medicines and Healthcare products Regulatory Agency (MHRA).
Find out more about Epilepsy medicines and pregnancy.
Specifically, they should discuss with you the risks to an unborn child of using sodium valproate (Epilim and other brand names) during pregnancy, including the greater risk with higher doses and when taking more than one anti-seizure medication.
Sodium valproate
In January 2024, new rules were introduced for prescribing sodium valproate.
Two specialists are now needed to approve:
- New or ongoing valproate treatments for girls and women.
- New valproate treatments for boys and men
The specialists must agree that your epilepsy does not respond to other treatments and the benefits of treatment outweigh the risks.
For girls and women, valproate can seriously harm an unborn baby when taken during pregnancy.
For boys and men, valproate may cause infertility. Some people’s fertility may return when their treatment is stopped or reduced. There is also some evidence that valproate can cause harm in the testicles of animals, but it’s unclear what this means for humans.
Never stop taking valproate before talking to your specialist first. Not taking medication as prescribed can increase the risk of a seizure.
Your epilepsy specialist will let you know when your treatment is due to be reviewed.
If you are planning a pregnancy it is important to speak to your healthcare professional as soon as possible about your treatment options.
If you have any questions or concerns about valproate, please speak to your healthcare professional.
Find out more about sodium valproate in the MHRA’s patient guide.
Find out more about Anti-seizure medications, contraception and pregnancy.
Pregnancy and monitoring
If you’re a young woman with epilepsy, and are pregnant and prescribed anti-seizure medication, you may be monitored more often if you:
- Have a learning disability
- Are aged under 16 years
- Have had a seizure within the past 12 months
- Have generalised tonic-clonic seizures (affecting both sides of the brain)
- Have adjustable risk factors for SUDEP
If you’re a young woman with epilepsy, and are planning a pregnancy, you may have your anti-seizure medication levels monitored if it’s thought there’s a risk your seizures might get worse.
Monitoring will be for a baseline (pre-conception) concentration of these anti-seizure medications:
- Carbamazepine (Tegretol and other brand names)
- Lamotrigine (Lamictal and other brand names)
- Levetiracetam (Keppra and other brand names)
- Oxcarbazepine (Trileptal and other brand names)
- Phenobarbital (Luminal and other brand names)
- Phenytoin (Dilantin and other brand names)
Your epilepsy specialists will also check that you’re taking your medication as prescribed.
If you’re a young woman with epilepsy, and are pregnant or planning a pregnancy, you’ll be monitored and your doses adjusted, as needed, if you’re taking:
- Carbamazepine (Tegretol and other brand names)
- Lamotrigine (Lamictal and other brand names)
- Levetiracetam (Keppra and other brand names)
- Oxcarbazepine (Trileptal and other brand names)
- Phenobarbital (Luminal and other brand names)
- Phenytoin (Dilantin and other brand names)
If your anti-seizure medication levels are monitored during pregnancy, the epilepsy specialists should discuss the results with you so you can make an informed choice about any adjustments to doses.
If your anti-seizure medication levels are changed during pregnancy, the epilepsy specialists should make a plan with you to return your medication, after birth, to the dosage level before you became pregnant.
Anti-seizure medications should begin to return to your pre-conception dosage levels in the first few days after the birth.
Breastfeeding
For most women taking anti-seizure medications, breastfeeding is generally safe and is encouraged.
You should be supported to choose a feeding method that bests suits you and your family.
Decisions about anti-seizure medications while breastfeeding should be made between you and your epilepsy specialist.
These should take into account the benefits of breastfeeding and the potential risks of the anti-seizure medication affecting your child.
Your epilepsy specialist should follow the latest guidance when prescribing anti-seizure medications while you’re breastfeeding.
