Editing Epilepsy (section)

== Contraception and pregnancy ==
{{See also|Epilepsy and pregnancy}}
Women of child-bearing age, including those with epilepsy, are at risk of [[unintended pregnancies]] if they are not using an effective form of [[contraception]].<ref name="King_2022">{{cite journal | vauthors = King A, Gerard EE | title = Contraception, fecundity, and pregnancy in women with epilepsy: an update on recent literature | journal = Current Opinion in Neurology | volume = 35 | issue = 2 | pages = 161–168 | date = April 2022 | pmid = 35191408 | pmc = 9230745 | doi = 10.1097/WCO.0000000000001039 }}</ref> Women with epilepsy may experience a temporary increase in seizure frequency when they begin [[hormonal contraception]].<ref name="King_2022" />

Some anti-seizure medications interact with enzymes in the liver and cause the drugs in hormonal contraception to be broken down more quickly. These [[enzyme inducer|enzyme inducing]] drugs make hormonal contraception less effective, and this is particularly hazardous if the anti-seizure medication is associated with birth defects.<ref name="SeizureMay2015">{{cite journal | vauthors = Reimers A, Brodtkorb E, Sabers A | title = Interactions between hormonal contraception and antiepileptic drugs: Clinical and mechanistic considerations | journal = Seizure | volume = 28 | pages = 66–70 | date = May 2015 | pmid = 25843765 | doi = 10.1016/j.seizure.2015.03.006 | doi-access = free }}</ref> Potent enzyme-inducing anti-seizure medications include [[carbamazepine]], [[eslicarbazepine acetate]], [[oxcarbazepine]], [[phenobarbital]], [[phenytoin]], [[primidone]], and [[rufinamide]]. The drugs [[perampanel]] and [[topiramate]] can be enzyme-inducing at higher doses.<ref name="EnzymeNice">{{cite web |title=Enzyme-inducing antiepileptic drugs |url=https://cks.nice.org.uk/topics/epilepsy/prescribing-information/enzyme-inducing-antiepileptic-drugs/ |website=NICE |access-date=2 November 2023 |date=May 2023}}</ref> Conversely, hormonal contraception can lower the amount of the anti-seizure medication [[lamotrigine]] circulating in the body, making it less effective.<ref name="King_2022" /> The failure rate of oral contraceptives, when used correctly, is 1%, but this increases to between 3–6% in women with epilepsy.<ref name="SeizureMay2015"/> Overall, [[intrauterine devices]] (IUDs) are preferred for women with epilepsy who are not intending to become pregnant.<ref name="King_2022" />

Women with epilepsy, especially if they have other medical conditions, may have a slightly lower, but still high, chance of becoming pregnant.<ref name="King_2022" /> Women with [[infertility]] have about the same chance of success with [[in vitro fertilisation]] or other forms of [[assisted reproductive technology]] as women without epilepsy.<ref name="King_2022" /> There may be a higher risk of [[pregnancy loss]].<ref name="King_2022" />

Once pregnant, there are two main concerns related to [[pregnancy]]. The first concern is about the risk of seizures during pregnancy, and the second concern is that the anti-seizure medications may result in [[birth defects]].<ref name="Bromley_2023" /> Most women with epilepsy must continue treatment with anti-seizure drugs, and the treatment goal is to balance the need to prevent seizures with the need to prevent drug-induced birth defects.<ref name="King_2022" /><ref name="pmid31782407">{{cite journal |vauthors=Tomson T, Battino D, Bromley R, Kochen S, Meador K, Pennell P, Thomas SV |date=December 2019 |title=Management of epilepsy in pregnancy: a report from the International League Against Epilepsy Task Force on Women and Pregnancy |journal=Epileptic Disorders |volume=21 |issue=6 |pages=497–517 |doi=10.1684/epd.2019.1105 |pmid=31782407|hdl=11336/119061 |hdl-access=free }}</ref>

Pregnancy does not seem to change seizure frequency very much.<ref name="King_2022" /> When seizures happen, however, they can cause some pregnancy complications, such as [[Preterm birth|pre-term births]] or the babies being [[Small for gestational age|smaller than usual]] when they are born.<ref name="King_2022" />

All pregnancies have a risk of birth defects, e.g., due to [[smoking during pregnancy]].<ref name="King_2022" /> In addition to this typical level of risk, some anti-seizure drugs significantly increase the risk of birth defects and [[intrauterine growth restriction]], as well as [[Developmental disorder|developmental]], [[Neurocognitive disorder|neurocognitive]], and [[Emotional and behavioral disorders|behavioral disorders]].<ref name="pmid31782407" /> Most women with epilepsy receive safe and effective treatment and have typical, healthy children.<ref name="pmid31782407" /> The highest risks are associated with specific anti-seizure drugs, such as valproic acid and carbamazepine, and with higher doses.<ref name="Bromley_2023" /><ref name="King_2022" /> [[Folic acid supplementation]], such as through [[prenatal vitamin]]s, reduced the risk.<ref name="King_2022" /> Planning pregnancies in advance gives women with epilepsy an opportunity to switch to a lower-risk treatment program and reduced drug doses.<ref name="King_2022" />

Although anti-seizure drugs can be found in [[breast milk]], women with epilepsy [[Breastfeeding and medications|can breastfeed]] their babies, and the benefits usually outweigh the risks.<ref name="King_2022" />