Safest Epilepsy Medication During Pregnancy and Risks

If you take seizure medication, there are things to consider if you are planning to become pregnant.

Read on to learn how anti-seizure medications can affect a pregnancy, which medications are considered the safest during pregnancy, and which medications to avoid if possible.

Risks of Seizures During Pregnancy

For most people with epilepsy, seizure frequency stays the same or even declines during pregnancy. For about 15{33c86113bcc32821f63c6372852a0f501e07fff55ce3ce61b15b246c5f8c531c} to 30{33c86113bcc32821f63c6372852a0f501e07fff55ce3ce61b15b246c5f8c531c} of pregnant people with epilepsy, seizure activity increases, typically in the first or third trimester.

Possible reasons for this increase include:

• Not taking medications as needed
• A change in how medications are processed during pregnancy, leading to lowered blood levels of the drug
• Hormone changes
• Water and sodium retention
• Stress
• Lack of sleep
• Vomiting medication before it is absorbed fully
• Weight gain from the pregnancy changing dosage needs

Seizures during pregnancy can pose a risk to the pregnant person and their unborn baby. The extent of these risks depends on the seizure type.

Focal Seizure With No Impairment of Awareness

• Person is usually aware and alert during the seizure
• Unless it becomes a generalized seizure, it poses little risk to the pregnant person or baby

Focal Seizure With Impairment of Awareness

• Can cause altered awareness and lead to injury
• May not directly affect the baby, but an injury to the pregnant person could harm the baby

Generalized Tonic-Clonic Seizure

• Also known as a grand mal seizure
• Person loses consciousness
• Muscles stiffen and then make jerking movements
• Risk of injury from falling or other trauma
• Can cause oxygen deprivation to the baby and/or lowered fetal heart rate
• Increased risk of premature labor and miscarriage

The risks from seizures while pregnant are generally considered greater than the risks of taking anti-seizure medications during pregnancy.

Taking Epilepsy Medication While Pregnant

The goal of taking anti-seizure medication during pregnancy is to find the fewest medications at the lowest dosage to adequately control seizures.

This may mean changing your current medication plan, but never stop taking, reducing, or changing your anti-seizure medications without talking to your neurologist or the healthcare provider in charge of your seizure management.

During pregnancy, the rate at which medications move through the body (called clearance) is faster, depending on the type of medication. Pregnancy hormones can also trigger liver enzymes which decrease blood levels of the medication.

Having epilepsy is associated with a moderate increase in risk for adverse outcomes with pregnancy, but generally not from medication use. A population-based cohort study published in 2017 that included more than 1.4 million singleton births found that antiepileptic drug use during pregnancy was generally not associated with adverse outcomes for the pregnant person or baby.

Risks of Seizure Medication to the Baby

The risk most associated with taking antiepileptic medications during pregnancy is the potential for congenital malformations (birth defects). While the rate of congenital malformations is higher for pregnant people taking antiepileptic medications, the overall risk is still low. There is a 2{33c86113bcc32821f63c6372852a0f501e07fff55ce3ce61b15b246c5f8c531c} to 3{33c86113bcc32821f63c6372852a0f501e07fff55ce3ce61b15b246c5f8c531c} occurrence of congenital malformations (which cannot always be predicted or prevented) in the general population, while pregnant people with epilepsy have a risk of about 4{33c86113bcc32821f63c6372852a0f501e07fff55ce3ce61b15b246c5f8c531c} to 6{33c86113bcc32821f63c6372852a0f501e07fff55ce3ce61b15b246c5f8c531c}. These risks may be more likely when multiple medications are used and at higher doses.

Possible risks include:

• Cleft lip/cleft palate (can usually be corrected with surgery)
• Neural tube defects, such as spina bifida (possibly due to some epilepsy medications interfering with blood levels of folic acid. Taking a higher dose of folic acid before and during pregnancy may prevent these defects)
• Cardiac defects
• Urinary and genital tract defects
• Withdrawal symptoms in the newborn (usually temporary and typically do not cause long-term effects)

Most medical professionals agree that the benefits of taking antiepileptic medication during pregnancy outweigh these risks.

Safest Epilepsy Medication During Pregnancy

Research on the safety of specific antiepileptic drugs during pregnancy is limited, particularly for newer medications.

Based on current information, the medications considered to have the lowest risks to the baby during pregnancy include:

• Lamictal (lamotrigine)
• Keppra (levetiracetam)
• Trileptal (oxcarbazepine)

These drugs’ blood levels can change dramatically during pregnancy and must be monitored.

The most important measure of medication continues to be that it controls seizures. Regardless of specific medication profiles, the goal is to use the most effective medication with the fewest potential negative effects.

Pregnant people with epilepsy are encouraged to enroll in the North American Anti-Epileptic Drug Pregnancy Registry to help increase knowledge about antiepileptic medication use during pregnancy.

Medications With Increased Risks

The medication most associated with risks to an unborn baby is valproate/valproic acid. The risk of major congenital malformations (such as spina bifida) with in-utero exposure to valproate is about 5{33c86113bcc32821f63c6372852a0f501e07fff55ce3ce61b15b246c5f8c531c} to 15{33c86113bcc32821f63c6372852a0f501e07fff55ce3ce61b15b246c5f8c531c}, especially when used with other anti-seizure medications. It may also increase the risk of developmental disorders.

Valproate products include:

• Depacon (valproate sodium)
• Depakote, Depakote CP, and Depakote ER (Divalproex sodium)
• Depakene and Stavzor (Valproic acid)
• Their generics

Other medications associated with higher risks include:

• Topamax (topiramate)
• Tegretol and others (carbamazepine)
• Solfoton (phenobarbital)
•  Dilantin (phenytoin)

If you are currently taking these medications, speak to your neurologist immediately.

Preparing for Pregnancy and Preventing Birth Defects

The risk for major birth defects is highest during the first trimester, particularly during week three to week eight. If getting pregnant is a possibility, preconception counseling with a specialist who knows about epilepsy and pregnancy can help you prepare beforehand and potentially lower these early pregnancy risks.

Stick to Your Treatment Plan

Never stop or change your medication or dosages without talking to your healthcare provider, even if you find out you are pregnant.

Your treatment plan may need to change if you are pregnant or planning to be, and extra monitoring (likely including testing blood levels of the medication) will be needed but should be done under the advisement of your healthcare provider.

Not adhering to your treatment plan can increase the risk of seizures and their associated risks.

Healthy Diet

Getting the right nutrition is important for all pregnant people, including those with epilepsy. This includes ensuring adequate weight gain (if advised), eating a variety of nutritious foods, and taking recommended supplements such as a prenatal multivitamin and folic acid.

Folic Acid

All people who may become pregnant are advised to take folate or a folic acid supplement to help prevent neural tube defects that can occur early in pregnancy. Typically, the dosage is 0.4 milligram per day, but people taking anti-seizure medication may need a higher dosage.

There is no universally agreed-upon dosage of folic acid supplements for people who are taking anti-seizure medication, but recommendations tend to be to take a multivitamin that contains 0.4 milligrams of folic acid, plus an additional 1 milligram to 5 milligrams per day, depending on deficiencies and the risk for neural tube defects. Follow your healthcare provider’s directions.

Vitamins

Prenatal vitamins that contain vitamin D can help address the lower levels of vitamin D that can be brought on by antiepileptic medication.

Selenium and zinc (found in a multivitamin with minerals) may also be beneficial.

Pregnant people taking enzyme-inducing antiepileptic drugs may be given vitamin K in the last month of pregnancy to prevent rare bleeding complications in their newborn. Their newborn is usually given vitamin K at birth as well.

Sleep

Getting adequate rest during pregnancy can be hard, but it’s important as lack of sleep can be a seizure trigger.

Avoid Harmful Substances

As with any pregnancy, harmful substances such as cigarettes, alcohol, and caffeine should be avoided.

Talk to Your Healthcare Provider

Early and regular prenatal care helps your chances of having a healthy pregnancy and managing your epilepsy. In addition to regular prenatal care, you will likely see your neurologist every month or every other month for monitoring of medication levels in your blood.

If you are planning to become pregnant, it’s a good idea to talk to your healthcare provider before conceiving. This way any necessary changes to your treatment plan can be made before you become pregnant.

Following up after birth is also important, as medication dosages may need to be adjusted.

Summary

Most people with epilepsy, including those taking antiepileptic medications, have healthy pregnancies and births.

While there are some risks associated with taking antiepileptic medications during pregnancy, the benefits of controlling seizures generally outweigh these risks. The risks tend to be higher with certain medications, when multiple medications are used, and/or with higher dosages.

Talk to your healthcare provider before making any changes to your medication plan.

A Word From Verywell 

If you are pregnant or plan to become pregnant, talk to your healthcare provider about what treatment plan is best for you and your pregnancy. Most people with epilepsy have healthy, safe pregnancies.