Prenatal Care and Epilepsy

By: Natalie L. Boehm, MBA, RBLP-T

Photo credit:

What is prenatal care?

Prenatal care is the care that a woman receives when she is expecting. Care can be given by an OB/GYN or a midwife. Prenatal care is important to make sure the fetus is developing properly and that the mother is receiving the care she needs. Prenatal care is important for any mother who is expecting, but it is especially important for mothers who are battling chronic illnesses such as epilepsy.

Pre-pregnancy care and Epilepsy

Many people do not talk about pre-pregnancy care, but it is important. It is best to plan a pregnancy, even if you are healthy. Unplanned pregnancies can happen and when they do, if a mother is chronically ill, it can put both her life and the fetus’ life at risk. For anyone who is battling a chronic illness, not just epilepsy, it is essential to take proper precautions and use protection to prevent an unplanned pregnancy.

When my husband Tobias and I decided to start a family, my seizures had been controlled for six years. We did a lot of research to see if I should get pregnant or if adoption would be a safer option. I met with my neurologist at the time and asked what risks were there. At the time I was on carbamazepine, topiramate, and lamotrigine. I was instructed to withdraw off my topiramate due to the risk of spinal bifida and cleft palate. Once I was off topiramate and did not have any seizures, he reduced my carbamazepine and lamotrigine in half and monitored me to see if any seizures would occur. After no seizures occurred, he gave me the ok to meet with my OB/GYN and discuss what precautions we should take to prevent any birth defects.

I met with my OB/GYN, and I was instructed to start taking a prenatal vitamin along with 4,000 mcg of folic acid. I was told to wait three months before trying to conceive to make sure that the supplements were in my system. My husband and I followed the doctor’s orders and then started trying to conceive. Two months after we started trying, we found out that we were expecting. Like any expecting parents, we were excited, yet nervous, wanting to make sure we did everything to have a healthy child.

Prenatal care and Epilepsy

Mothers who are expecting need to make sure that their neurologist and OB/GYN are communicating to make sure everyone is on the same page when it comes to care. Your OB/GYN and neurologist may have you coming in more frequently to make sure you are doing well, and that the fetus is not developing any complications. Many mothers, including myself, must stay on their medication throughout their pregnancy. It is important for expecting mothers to eat well, take their prenatal vitamins, get proper sleep, and avoid using illegal substances, alcohol, or smoke.

The Importance of Planning for a Pregnancy

When battling epilepsy, it is important to plan your pregnancy to prevent birth defects from medication, which commonly occurs in the first trimester. According to Mayo Clinic, birth defects caused by anticonvulsant medication are cleft palate, neural tube defects, skeletal abnormalities, and congenital heart and urinary tract defects. The risk of these defects increases with high doses of anticonvulsants or if a patient is on more than one anticonvulsant.

In the article, The management of epilepsy in pregnancy, the authors stress the importance of screening for possible birth defects. The authors recommend an ultrasound between the 11-13th weeks of pregnancy, doctors are looking for signs of acrania (absence of fetal skull, exposing brain to amniotic fluid), cardiac and structural defects.

The authors also point out the risk percentages that anticonvulsant medication:

Carbamazepine 4.6% (3.5-5.8%)

Lamotrigine 2.9% (2-3.8%)

Phenobarbital 4.9% (3.2-6.6%)

Phenytoin 7.4% (3.6-11.1%)

Valproate 10.7% (8.2-13.2%)

                                                                                                                    (Walker et. al., 2009)

Along with physical defects, anticonvulsant medication can also have an effect on cognitive development. Learning disabilities, a decrease in neuropsychological performance, and a reduced verbal IQ are a risk, especially children who were exposed to valproic acid while in utero (Walker et. al., 2009). Because of these risks, it is essential that anyone who is battling epilepsy who wants to start a family take the proper precautions needed to have a safe and healthy pregnancy.

Doctor-Patient Communication

As important as it is to collaborate with your doctors to prepare to become pregnant, once you are pregnant, your relationship with your doctors is essential. Before trying to become pregnant, I made sure I was with doctors who were ready to answer my questions, take my birth plan seriously, and knew that this was a team effort. If you see a doctor who says, ‘I don’t have time to answer questions,’ that is not a doctor you want to be a part of this process.

First Trimester

During the first trimester, many changes start to take place, as the embryo develops inside the uterus. According to John Hopkins, from weeks zero to eight, the fetus is called an embryo. By the end of the first trimester, the fetus is averaging 0.5-1 ounces in weight and averages three to four inches in length (John Hopkins, 2022). This is the time that complications can arise that is why it is important to talk to your doctors about medication options before conceiving.

According to Mayo Clinic, common symptoms of pregnancy are:

Tender, swollen breasts

Nausea with or without vomiting

Increased urination


Food cravings and aversions



                                                                                                                                             (Mayo Clinic, 2020)

Benchmarks During First Trimester

According to John Hopkins, the chart below explains the normal benchmarks for the average fetal development:

By the end of four weeks:

  • All major systems and organs begin to form.
  • The embryo looks like a tadpole.
  • The neural tube (which become the brain and spinal cord), the digestive system, and the heart and circulatory system begin to form.
  • The beginnings of the eyes and ears are developing.
  • Tiny limb buds appear, which will develop into arms and legs.
  • The heart is beating.

By the end of eight weeks:

  • All major body systems continue to develop and function, including the circulatory, nervous, digestive, and urinary systems.
  • The embryo is taking on a human shape, although the head is larger in proportion to the rest of the body.
  • The mouth is developing tooth buds, which will become baby teeth.
  • The eyes, nose, mouth, and ears are becoming more distinct.
  • The arms and legs can be easily seen.
  • The fingers and toes are still webbed but can be clearly distinguished.
  • The main organs continue to develop, and you can hear the baby’s heartbeat using an instrument called a Doppler.
  • The bones begin to develop, and the nose and jaws are rapidly developing.
  • The embryo is in constant motion but cannot be felt by the mother.

From embryo to fetus:

  • After 8 weeks, the embryo is now referred to as a fetus, which means offspring.
  • Although the fetus is only 1 to 1.5 inches long at this point, all major organs and systems have been formed.

During weeks nine to twelve:

  • The external genital organs are developed.
  • Fingernails and toenails appear.
  • Eyelids are formed.
  • Fetal movement increases.
  • The arms and legs are fully formed.
  • The voice box (larynx) begins to form in the trachea.

                                                                                                                                            (John Hopkins Medicine, 2022)

Second Trimester

During the second trimester, first trimester symptoms such as nausea and morning sickness start to decrease. New symptoms will start due to the changes that are taking place. According to Mayo Clinic, common symptoms of the second trimester are:

  • Growing belly and breasts
  • Braxton Hicks contractions (mild, irregular contractions)
  • Skin changes (increase in melanin due to hormones increase)
  • Nasal problems
  • Dental issues (gum sensitivity)
  • Dizziness
  • Leg cramps
  • Vaginal discharge
  • Urinary tract infections (any signs of infection, contact your doctor)

                                                                                                                (Mayo Clinic, 2020)

According to John Hopkins, by the end of the second trimester, the fetus is anywhere from 13 to 16 inches long and weighs around two to three pounds. Changes during the second trimester are:

  • The fetus kicks, moves, and can turn from side to side
  • The eyes have been gradually moving to the front of the face, and the ears have moved from the neck to the sides of the head. The fetus can hear your voice.
  • A creamy white substance (known as vernix) begins to appear on the fetus and helps to protect the thin fetal skin. Vernix is gradually absorbed by the skin, but some may be seen on babies even after birth.
  • The fetus is developing reflexes, like swallowing or sucking.
  • The fetus can respond to certain stimuli.
  • The placenta is fully developed.
  • The brain will undergo its most important period of growth from the fifth month on.
  • Fingernails have grown on the tips of the fingers and toes, and the fingers and toes are fully separated.
  • The fetus goes through cycles of sleep and wakefulness.
  • Skin is wrinkly and red, covered with soft, downy hair (called lanugo).
  • Hair is growing on the head of the fetus.
  • Fat begins to accumulate in the fetus.
  • Eyelids are beginning to open, and the eyebrows and eyelashes are visible.
  • Fingerprints and toeprints have formed.
  • Rapid growth is continuing in fetal size and weight.
  • The 20th week marks the halfway point of the pregnancy.
  • A fetus born at the end of 24 weeks may survive in a neonatal intensive care unit.

                                                                                                                                (John Hopkins Medicine, 2022)

Third Trimester

The third trimester can be challenging for expecting mothers. As your due date gets closer, many mothers feel uncomfortable and are looking forward to delivering. Many mothers are also anxious to deliver, especially first-time mothers. Do what you can to relax and prepare yourself. Taking a bath, doing yoga, and meditating are just a few examples of what you can do to help your body as you progress through the third trimester. According to Mayo Clinic, common symptoms of the third trimester are:

  • Braxton Hicks contractions
  • Backaches
  • Shortness of breath
  • Heartburn
  • Spider veins, varicose veins, and hemorrhoids
  • Frequent urination

                                                                                                (Mayo Clinic, 2020)

According to John Hopkins, during the third trimester, the fetus is beginning to position itself head down, to prepare for vaginal birth. Not all fetuses do so, if a baby is breeched, many doctors will opt to perform a c-section if the baby is not in the proper position. By the end of the third trimester, the average fetus is 19 to 21 inches in length and can weigh six to nine pounds. Changes during the third trimester are:

  • The fetus can see and hear
  • The brain continues to develop
  • The kidneys and lungs continue to mature
  • By the 36th week, the head may “engage” (drop into the pelvic area), a process called lightening
  • The bones of the skull remain soft to make it easier to pass through the birth canal
  • For many babies, the irises of the eyes are slate blue. The permanent eye color will not appear until several days or weeks after birth
  • The fetus can suck its thumb and has the ability to cry
  • By 38 to 40 weeks, the fetus’ lanugo (fine, soft hair on the body and limbs) has disappeared almost completely
  • By 38 to 40 weeks, the lungs have matured completely
  • The baby is covered in vernix caseosa (vernix), a creamy protective coating on the skin
  • The head will usually turn downward during the last couple of weeks of pregnancy

                                                                                                                                (John Hopkins Medicine, 2022)

Resources Available during pregnancy

Because my pregnancy was considered high risk due to epilepsy, to prepare myself, I hired a doula to help me prepare for my pregnancy and delivery. While going through pregnancy, she helped me to create a birth plan, letting the doctors and nurses know what my goals were for my labor and delivery. A birth plan is important, and you want to review your birth plan with your OB/GYN to make sure you both agree to what your goals are. Terminology is also important because what you want to take place while in labor and what might happen can be very different. I wanted the option not to have an epidural and to be able to deliver in a position that was comfortable for me. When writing my birth plan, I did not create sentences such as “I do not want an epidural” because doctors are not going to agree to that. Instead, I wrote “I would prefer not to have an epidural, however, if a situation arises that one is necessary, I will agree to have one.” Meet the doctor halfway, because if you act as if it is your way or no way, that is going to cause tension between you and your doctor. Be honest about your goals with your doctor when it comes to going through your pregnancy and delivery, but also let your doctor know you realize that changes may need to be made depending on what takes place. Being able to have a positive relationship with your doctor is important for both you and your baby. If you want to create a birth plan, there are many articles and templates you can research that can help you in deciding what is best for you and your baby. The American Pregnancy Association has a great article that helps you decide what you need to consider, what to put in your plan, and the best way to word it:

For many first-time parents, childbirth classes are a great way to learn about the development of the baby, different types of births, and how to prepare for delivery. The American Pregnancy Association provides free resources for parents in helping to prepare for pregnancy, while pregnant, labor and delivery, and post-partum recovery. You can go to their website at for more information.


Prenatal care is the care that a woman receives when she is expecting. It is important to work with your OB/GYN and neurologist even before becoming pregnant. As you progress through your pregnancy, communication is essential for both the fetus and mother. There are many resources available to help expecting mothers as they go through their pregnancy and prepare for childbirth.


American Pregnancy Association (2021). Home page. American Pregnancy Association. Retrieved from:

American Pregnancy Association (2021). Creating Your Birth Plan. American Pregnancy Association. Retrieved from:

John Hopkins (2022). The First Trimester. John Hopkins Medicine. Retrieved from:

John Hopkins (2022). The Second Trimester. John Hopkins Medicine. Retrieved from:

John Hopkins (2022). The Third Trimester. John Hopkins Medicine. Retrieved from:

Mayo Clinic (2020). Epilepsy and Pregnancy: What you need to know. Mayo Clinic. Retrieved from:

Mayo Clinic (2020). Pregnancy week by week, 1st trimester pregnancy: What to expect. Mayo Clinic. Retrieved from:

Mayo Clinic (2020). Pregnancy week by week, 2nd trimester pregnancy: What to expect. Mayo Clinic. Retrieved from:

Mayo Clinic (2020). Pregnancy week by week, 3rd trimester pregnancy: What to expect. Mayo Clinic. Retrieved from:

Walker, S.P., Permezel, M., & Berkovic, S.F. (2009). The management of epilepsy in pregnancy. BLOG: an International Journal of Obstetrics and Gynaecology, 116(6), 758-767.

Read More