Pregnancy and Epilepsy
What changes, what needs monitoring, and why planning matters
Most people with epilepsy can have a safe pregnancy and a healthy baby.
Pregnancy does, however, create some additional considerations.
These include:
seizure control
antiseizure medicines
folic acid
changes in medicine levels
pregnancy-related sickness
sleep
antenatal monitoring
and planning for birth and the period after delivery.
The aim is not to remove every possible risk. It is to balance good seizure control with the lowest reasonable risk from treatment.
Planning before pregnancy
Ideally, epilepsy treatment should be reviewed before conception.
This gives the epilepsy specialist an opportunity to look at:
the type of epilepsy
seizure frequency
current medicines
medicine doses
previous treatment responses
pregnancy risks associated with the medicine
whether one medicine rather than several could control seizures
and whether medicine levels should be measured before pregnancy.
NICE recommends discussing reproductive health and pregnancy as part of routine epilepsy care rather than waiting until someone is already pregnant.
This is often called pre-conception counselling.
Do not stop epilepsy medicine when planning a baby
Someone may understandably worry after reading that some antiseizure medicines carry pregnancy risks.
But suddenly stopping treatment can itself be dangerous.
Loss of seizure control can lead to:
more frequent seizures
more severe seizures
tonic-clonic seizures
status epilepticus
falls and injuries
and increased epilepsy-related risk.
Medication should therefore be reviewed with an epilepsy specialist rather than stopped independently.
What if the pregnancy was not planned?
An unexpected pregnancy does not mean antiseizure medicine should suddenly be stopped.
Continue taking prescribed epilepsy medicine and contact the GP, maternity service or epilepsy team urgently for review.
The NHS specifically advises people who unexpectedly become pregnant while taking epilepsy medication to seek specialist advice as soon as possible while continuing their treatment until advised otherwise.
The risks of medicine exposure and the risks of uncontrolled epilepsy need to be considered together.
Folic acid
Folic acid is important before and during early pregnancy because it helps reduce the risk of neural-tube defects.
Current NICE guidance recommends 5 mg of folic acid daily for people who are planning pregnancy or are in the first 12 weeks of pregnancy if they take medicines that can affect folic-acid metabolism, including antiseizure medicines.
This is a prescription-strength dose.
Ideally it should be started before conception.
If pregnancy has already occurred and folic acid was not being taken, contact the GP or maternity team rather than assuming it is too late to begin.
Does folic acid remove the medicine-related risks?
No.
Folic acid is important, but it cannot make every antiseizure medicine safe in pregnancy.
For example, MHRA guidance specifically states that folate supplementation has not been shown to prevent the congenital abnormalities associated with valproate exposure.
Folic acid should therefore be considered one part of pregnancy care, not a substitute for appropriate medicine review.
Do seizures usually get worse during pregnancy?
Not necessarily.
Many people notice no major change.
Some experience fewer seizures, while others experience an increase. Epilepsy Action reports that around one in three people with epilepsy may experience increased seizures during pregnancy.
There are several possible reasons why seizure control might change, including:
changing medicine levels
vomiting
missed doses
sleep deprivation
physical stress
illness
hormonal and metabolic changes
or progression of the underlying epilepsy.
A change in seizure frequency during pregnancy should be discussed with the maternity and epilepsy teams.
Pregnancy can change medicine levels
Pregnancy causes major changes in:
blood volume
kidney function
liver metabolism
hormone levels
and the way medicines are distributed and cleared from the body.
As a result, the blood concentration of some antiseizure medicines may fall during pregnancy even though the person is taking exactly the same dose.
This is particularly important for medicines such as:
lamotrigine
levetiracetam
carbamazepine
oxcarbazepine
phenobarbital
and phenytoin.
NICE recommends considering a pre-conception baseline medicine concentration when monitoring is appropriate and adjusting treatment during pregnancy according to clinical need and MHRA guidance.
Why is a pre-pregnancy medicine level useful?
A medicine level taken while seizures are controlled before pregnancy can provide a useful reference.
During pregnancy, later blood tests can then be compared with that individual's own usual level.
This can sometimes help explain:
breakthrough seizures
side effects
or whether a dose adjustment might be needed.
A laboratory number should not be interpreted on its own. Seizure control, side effects, adherence and the person's individual history remain important.
Lamotrigine during pregnancy
Lamotrigine is one of the better-studied antiseizure medicines in pregnancy.
The MHRA review found that data from more than 12,000 pregnancies exposed to lamotrigine monotherapy did not show an increased rate of major congenital abnormalities compared with the general population.
However, pregnancy can substantially increase the clearance of lamotrigine.
This means blood levels may fall and seizures can break through unless treatment is appropriately monitored.
After delivery, clearance can return towards normal quickly, so a dose that was necessary during pregnancy may become too high after birth.
NICE therefore recommends making a plan during pregnancy for returning medicines towards pre-conception doses after delivery where pregnancy-related dose increases were required.
Levetiracetam during pregnancy
Levetiracetam is also relatively well studied.
The MHRA review found that available data did not indicate an increased risk of major congenital abnormalities compared with the general population.
Like lamotrigine, levetiracetam levels can fall during pregnancy.
Monitoring may therefore be considered, particularly if seizure control has previously depended on maintaining a particular medicine level.
Are lamotrigine and levetiracetam completely risk-free?
No medicine can be described as completely risk-free.
The MHRA considers lamotrigine and levetiracetam among the safer antiseizure medicines reviewed during pregnancy, particularly in relation to major congenital malformations.
However, evidence about some longer-term neurodevelopmental outcomes is less extensive than the congenital-malformation data.
Treatment decisions should therefore still be individual.
Some antiseizure medicines carry greater pregnancy risks
Pregnancy risks differ substantially between medicines.
The MHRA review found an increased risk of major congenital abnormalities with:
carbamazepine
phenobarbital
phenytoin
topiramate
and particularly valproate.
Evidence for some newer or less studied medicines remains limited.
This is why it is inaccurate simply to say that “epilepsy medication is dangerous in pregnancy”.
The specific medicine and dose matter.
Valproate and pregnancy
Valproate carries particularly significant pregnancy risks.
Current MHRA information states that around 1 in 9 babies exposed to valproate during pregnancy may have a birth defect.
Prenatal valproate exposure is also associated with substantial risks to development and learning.
Because of these risks, strict prescribing and Pregnancy Prevention Programme requirements apply in the UK.
What if someone taking valproate becomes pregnant?
Do not stop valproate suddenly.
Contact the epilepsy specialist urgently.
For some epilepsy syndromes, stopping an effective treatment can create serious seizure risk, so the decision must be made with specialist input.
Where valproate is continued during pregnancy because there is no suitable alternative, specialist prenatal monitoring is required.
Related Information Hub page:
Valproate and Pregnancy — coming later
Topiramate and pregnancy
Topiramate also has important pregnancy risks.
The MHRA has identified increased risks including:
congenital abnormalities
low birth weight
and possible increased risk of neurodevelopmental conditions.
Under current UK rules, topiramate should not be used for epilepsy during pregnancy unless there is no suitable alternative treatment.
A Pregnancy Prevention Programme applies to women and girls who could become pregnant.
What if someone taking topiramate becomes pregnant?
If topiramate is being taken for epilepsy, it should not suddenly be stopped.
The MHRA advises contacting the GP or epilepsy team urgently because stopping treatment abruptly can cause seizures to recur, become more frequent or last longer.
The advice is different when topiramate is being used solely for migraine prevention, which is why the prescriber needs to know exactly why it is being taken.
Is one medicine better than several?
When possible, specialists often aim to control epilepsy with the lowest effective dose of a single suitable medicine.
This is known as monotherapy.
However, seizure control remains crucial.
Some people need more than one medicine to control their epilepsy, and reducing treatment simply to achieve monotherapy may not be safe.
The correct balance is individual.
Morning sickness can affect seizure control
Vomiting can interfere with epilepsy treatment if tablets are not absorbed.
If someone repeatedly vomits after taking antiseizure medicine or cannot keep medication down, they should contact their GP, maternity team or epilepsy team promptly.
Do not automatically take an extra dose unless a healthcare professional advises it, because whether a replacement dose is appropriate depends on:
the medicine
when it was taken
and how soon vomiting occurred.
Sleep remains important
Pregnancy can disturb sleep because of:
nausea
discomfort
needing to urinate frequently
foetal movement
anxiety
reflux
or insomnia.
For people whose seizures are sensitive to sleep deprivation, this can become important.
Planning rest, asking for help and discussing severe sleep problems with the healthcare team may help reduce avoidable seizure triggers.
Sleep becomes particularly important again after the baby is born.
Can seizures harm the baby?
The effect depends on the seizure type and circumstances.
A brief focal seizure without a fall may carry very different risks from a prolonged bilateral tonic-clonic seizure.
Tonic-clonic seizures may cause:
temporary reduction in oxygen reaching the baby
falls
abdominal trauma
bleeding
premature labour
or other complications.
Status epilepticus is a medical emergency.
The purpose of continuing effective epilepsy treatment during pregnancy is therefore not only to protect the pregnant person but also to reduce seizure-related risk to the pregnancy.
What happens after a tonic-clonic seizure during pregnancy?
Seek medical advice promptly.
Assessment may be needed to check:
the pregnant person's recovery
injuries
medication
and the baby's wellbeing.
If there has been a significant fall or abdominal injury, contact maternity services urgently.
The NHS advises calling 999 if a seizure lasts longer than usual or more than five minutes when the usual duration is unknown, or if another seizure occurs before normal recovery.
A seizure in pregnancy is not always epilepsy
This is particularly important later in pregnancy.
Eclampsia is a serious complication of pre-eclampsia that causes seizures.
Pre-eclampsia most commonly develops from around 20 weeks of pregnancy and may cause symptoms such as:
severe headache
visual disturbance
pain below the ribs
vomiting
sudden swelling
or feeling very unwell.
Eclampsia can also occur after delivery.
A new or unusual seizure during pregnancy should therefore never automatically be assumed to be the person's usual epilepsy.
Antenatal care
Pregnant people with epilepsy may have additional appointments involving:
a midwife
obstetrician
neurologist
epilepsy specialist nurse
pharmacist
and other specialists where needed.
The exact level of monitoring depends on:
seizure control
epilepsy type
medicine
pregnancy history
and other health conditions.
The NHS advises that people with epilepsy will usually be offered additional appointments and tests during pregnancy.
Pregnancy scans
Routine NHS pregnancy scans are still offered.
Additional or more detailed fetal assessment may be recommended depending on:
which antiseizure medicine has been used
the dose
whether more than one medicine is taken
and other pregnancy risk factors.
Medicine exposure does not mean that a baby will necessarily have a problem.
Monitoring is intended to identify concerns where possible and give families appropriate information and support.
The UK Epilepsy and Pregnancy Register
Pregnant people with epilepsy in the UK can contribute to the UK Epilepsy and Pregnancy Register.
The register collects information about epilepsy treatments and pregnancy outcomes to improve understanding of antiseizure-medicine safety.
Research of this kind has been important in identifying differences between medicines and improving future counselling.
Planning the birth
Having epilepsy does not automatically mean someone needs a caesarean section.
Most people with epilepsy can have a vaginal birth.
The maternity team may recommend birth in a hospital environment so emergency treatment is available if a seizure occurs.
A birth plan can include:
the person's usual seizure type
known triggers
regular medication times
emergency medication
what usually happens during recovery
who should be contacted
and what support the person prefers.
Related Information Hub page:
Labour, Birth and Epilepsy — coming later
Continue epilepsy medication during labour
Regular antiseizure medicine should normally continue during labour unless the healthcare team specifically advises otherwise.
Missing medication during a long labour can increase seizure risk.
Taking the person's usual medicine to hospital can help avoid unnecessary delays.
After the baby is born, medication may need changing again
Pregnancy-related changes in the body begin reversing after delivery.
If an antiseizure medicine dose was increased during pregnancy, continuing that higher dose indefinitely may cause toxicity.
NICE recommends making an antenatal plan to return medicines towards the pre-conception dose, with this process beginning in the first few days after birth where appropriate.
The exact schedule depends on the medicine and individual circumstances.
Do not reduce it without the planned medical advice.
Breastfeeding
Epilepsy itself does not prevent breastfeeding.
Most people taking commonly used antiseizure medicines can breastfeed, although medicines differ in how much enters breast milk.
The decision should consider:
the medicine
dose
whether several medicines are used
whether the baby was premature
and the baby's health.
Possible medicine-related signs in a breastfed baby can include:
unusual sleepiness
poor feeding
poor weight gain
or, with particular medicines, other specific side effects.
Any concerns should be discussed with the baby's healthcare team.
Sleep deprivation after birth
For some parents with epilepsy, the early postnatal period can be particularly challenging because sleep becomes fragmented.
Lack of sleep and missed medication are common seizure triggers.
Planning support before the baby arrives can therefore be part of epilepsy safety.
This may include arranging help with:
night feeds
medication reminders
household tasks
and opportunities for uninterrupted sleep.
Epilepsy Action specifically recommends planning around sleep and medication after delivery.
Safety when caring for a baby
Parents who continue to have seizures may need practical adjustments when caring for a baby.
The appropriate precautions depend heavily on the type of seizures.
Examples can include:
changing the baby on the floor rather than a raised surface
avoiding carrying the baby up and down stairs when seizure risk is high
using safer bathing arrangements
feeding while seated safely
having another adult available when possible during higher-risk periods
and avoiding bed-sharing where seizures or sedating medication could put the baby at risk.
These are safety adaptations, not evidence that someone with epilepsy cannot care for their child.
When should someone seek urgent advice during pregnancy?
Contact the maternity or epilepsy team urgently if:
seizures become more frequent
seizures become more severe
a new seizure type appears
medication cannot be kept down because of vomiting
several doses have been missed
significant medication side effects develop
there has been a fall or abdominal injury
or there are concerns about reduced seizure control.
The NHS specifically advises urgent review when seizures change during pregnancy or vomiting is affecting medication.
When should 999 be called?
Call 999 for a seizure during pregnancy when:
the seizure lasts longer than usual
it continues for more than five minutes when the person's usual duration is unknown
another seizure begins before recovery
breathing is seriously affected
there is serious injury
or the person's condition is otherwise immediately concerning.
Pregnancy does not replace ordinary seizure first-aid principles, but there may be additional reasons for maternity assessment afterwards.
Related Information Hub page:
Seizure First Aid
Questions to ask before or during pregnancy
Useful questions for the epilepsy team can include:
Is my current medicine suitable for pregnancy?
Are there safer alternatives for my type of epilepsy?
Should treatment be changed before conception?
Should I take 5 mg folic acid?
Should my medicine level be measured before pregnancy?
Will blood levels need checking during pregnancy?
What should I do if I vomit after taking my medicine?
What should I do if seizures increase?
What are the pregnancy risks associated with my particular medicine?
What monitoring will my baby need?
Should my dose change after delivery?
Can I breastfeed while taking this medicine?
What should be included in my birth and postnatal seizure plan?
Writing the answers down can make them easier to refer to later.
The most important message
Epilepsy and pregnancy require planning, not panic.
Most people with epilepsy have healthy pregnancies.
The safest approach is usually to maintain good seizure control while choosing the most appropriate antiseizure treatment for that individual.
Pregnancy can change medicine levels and seizure patterns, which is why specialist review and monitoring may be needed.
Folic acid should ideally begin before conception.
Valproate and topiramate require particular caution because of their established pregnancy risks.
And if pregnancy happens unexpectedly, do not suddenly stop antiseizure medicine.
Contact the epilepsy and maternity teams promptly so the risks of both treatment and uncontrolled seizures can be considered together.
Sources and further reading
NHS — Epilepsy and pregnancy.
Current NHS guidance covering pregnancy planning, seizures, medicines, urgent care, breastfeeding and the UK Epilepsy and Pregnancy Register. Page reviewed February 2026.
NICE — Epilepsies in children, young people and adults (NG217).
Current UK guidance covering reproductive counselling, medicine monitoring, pregnancy, breastfeeding and postnatal dose planning.
NICE — Maternal and child nutrition (NG247).
Current guidance recommends 5 mg folic acid for people taking medicines that can affect folate metabolism, including antiseizure medicines, when planning pregnancy and during the first 12 weeks.
MHRA — Epilepsy medicines and pregnancy.
UK regulatory review of congenital-malformation, neurodevelopmental and fetal-growth risks associated with individual antiseizure medicines.
MHRA — Valproate: reproductive risks.
Current UK restrictions, Pregnancy Prevention Programme requirements and pregnancy-risk information for valproate.
MHRA — Topiramate Pregnancy Prevention Programme.
Current UK restrictions and pregnancy-safety information concerning topiramate.
Epilepsy Action — Pregnancy and epilepsy.
UK information covering pregnancy planning, seizure changes, medicines, pregnancy monitoring and seizure risk.
Epilepsy Action — Epilepsy medicines and pregnancy.
Detailed UK patient information on individual antiseizure medicines and pregnancy. Updated February 2026.
Information reviewed: September 2026.
This page provides general educational information and does not replace individual advice from an epilepsy specialist, GP, midwife, obstetrician, pharmacist or other healthcare professional.
