With the right medical support, people with narcolepsy can have healthy, complication-free pregnancies. However, it is vital to discuss pregnancy plans with a doctor, as a person may need to change or stop their medication.

Certain narcolepsy medications may increase the risk of congenital abnormalities (also known as birth defects). This means that people who are trying to conceive or who are already pregnant may need to manage their symptoms in other ways.

Narcolepsy symptoms can also change or intensify during pregnancy. Most pregnant people experience fatigue due to hormonal changes. These hormonal changes could make narcolepsy symptoms more difficult to manage.

A doctor who specializes in narcolepsy can work with a pregnant person and their obstetrician or midwife to manage symptoms and contribute to a safe pregnancy. Keep reading to learn more about narcolepsy and pregnancy.

A pregnant person lying down on a sofa with headphones on.Share on Pinterest
Oscar Wong/Getty Images

Most research to date suggests narcolepsy itself does not negatively affect pregnancy outcomes. A 2013 study of 249 pregnant people in Europe found similar rates of pregnancy complications in those with narcolepsy as in the general population.

However, narcolepsy can affect pregnancy in other ways. For example, people who experience cataplexy may be at risk of falls or injuries, which could affect pregnancy.

Additionally, a 2021 study reports that 94.2% of pregnant people experience fatigue. This fatigue can be intense and may affect daily functioning.

In people with narcolepsy, their symptoms may be more intense than usual. Because of this, pregnant people with narcolepsy require frequent monitoring by a doctor or midwife.

There is not much research on the impact pregnancy has on narcolepsy symptoms. The biggest impact may come from stopping narcolepsy medications, as doing so may make symptoms worse during the pregnancy.

In a 2019 study of pregnant people with narcolepsy, 78.7% stopped taking their medication. To manage the consequences of this:

  • 72.1% slept more
  • 32.6% stopped working
  • 27.9% stopped driving

It is unclear if pregnancy makes any long-term difference to someone’s narcolepsy symptoms once the pregnancy is over.

The most common narcolepsy medications increase the risk of congenital abnormalities. The risk may be especially high during the first trimester. For this reason, a person may need to stop taking narcolepsy medications before they try to become pregnant.

In a 2020 study of people who took modafinil and armodafinil during pregnancy, the risk of congenital abnormalities in the medication group was 13%, compared with 3% in the general population. Some congenital abnormalities may require pregnancy interventions or a change in delivery plans to keep the baby as safe as possible during birth.

The most common congenital abnormalities included:

  • congenital torticollis, which is when a short or tight neck muscle that causes the neck to tilt
  • hypospadias, which is when the opening of the urethra is not located at the tip of the penis in males
  • congenital heart abnormalities

In the 2019 study of people with narcolepsy, most participants said they stopped taking medication during past pregnancies, with 82.9% citing fears of harming the fetus as a motivation. 58.5% said their doctor recommended they stop taking medication.

However, some medications may be safe to take during pregnancy, so it is important to discuss all the options with a doctor either before becoming pregnant or at the earliest opportunity after conceiving.

A 2017 study suggests that people who have narcolepsy with cataplexy might have higher rates of gestational diabetes. However, the study was fairly small, involving 25 people who had narcolepsy with cataplexy and 75 who did not have narcolepsy.

Of the participants, 13.6% of people with narcolepsy had gestational diabetes, compared with 4.3% who did not have narcolepsy.

Gestational diabetes may increase the risk of having a very large baby, which in turn can increase the likelihood of:

  • needing an induction or C-section
  • low blood sugar in the fetus
  • respiratory distress in the fetus

However, even with the difference in rates, there were no significant differences in pregnancy outcomes between the two groups in the study.

Managing blood sugar levels with diet, lifestyle, and, if necessary, insulin can reduce the risk of complications.

People with narcolepsy can give birth in the same way as others. There is a possibility of cataplexy happening during or after the birth, but medical care and support can ensure people do not fall.

Some people with narcolepsy may choose to have a C-section so that the birth is more controlled, according to 2012 research. This allows people to schedule when birth takes place and may relieve some fears about what will happen if they experience cataplexy during labor.

No specific guidelines suggest that a C-section is the best delivery method for people with narcolepsy or that it leads to better outcomes. Pregnant people should discuss their options with a doctor.

Newborns can wake frequently from sleep and do not sleep according to adult schedules. As a result, many new parents experience periods of sleeplessness and exhaustion. For a person with narcolepsy, this may be even more challenging.

It may help to have a plan in place to ensure that parent and baby are both getting what they need. This may involve:

  • if possible, dividing child care tasks equitably between partners, taking narcolepsy into account
  • if this is not possible, hiring someone to help take care of the baby or enlisting help from a family member or friend
  • talking with a lactation expert about safely breastfeeding with narcolepsy
  • taking naps when the baby is asleep
  • talking with a doctor about when it is safe to take narcolepsy medications again

People with narcolepsy often have healthy pregnancies, and research suggests they are no more likely to experience complications than the rest of the population. However, pregnancy with narcolepsy does come with some unique considerations and challenges.

To make pregnancy and birth as safe as possible, it is best to speak with a doctor before trying to conceive. They can explain the types of support a person might need and whether someone should stop taking their narcolepsy medication. If a person is already pregnant, they should speak with a doctor about this as soon as possible.

Developing a pregnancy and postpartum plan can also be helpful. Try working with a partner, family members, close friends, or a doula to devise and implement strategies to manage the transition to parenthood.