Epilepsy medicines and pregnancy

Always get medical advice before making any changes to your epilepsy medicine.

Will taking epilepsy medicines affect my unborn baby?

If you take certain epilepsy medicines during pregnancy, they might increase your risk of
having a baby with a physical birth abnormality. They might also harm the baby’s growth or
development. The highest risk is between weeks 1 and 13 of your pregnancy.

Some epilepsy medicines have a higher risk of harming a baby during pregnancy than others.
Taking a higher dose or more than one epilepsy medicine at the same time may also increase
the risk of harm.

Most women with epilepsy have healthy pregnancies and give birth to healthy babies. But, it
is important that you get the right information and support about which medicines to take.

Which epilepsy medicine should I take?

This depends on the type of epilepsy and seizures you have, as well as your age.

To have the best chance of having a healthy pregnancy, medical professionals advise you
have pre-conception counselling before you become pregnant. Having preconception
counselling before you start trying for a baby gives you the time to make changes to your
epilepsy medicines, should you need to. It also gives you time to have your questions
answered by a doctor or nurse who knows about pregnancy and epilepsy. Being more
informed about epilepsy and epilepsy medicines means you are better prepared for
pregnancy and making decisions about your treatment.

If you are already pregnant, don’t stop taking your epilepsy medicine. This could cause you
to have more seizures or seizures that are more severe. This could be harmful for you and
your baby. Instead, speak to your GP urgently, so they can get you the help and advice you
need.

Epilepsy Action has more information about epilepsy and having a baby.

What are the risks for different epilepsy medicines?

The Medicine and Healthcare products Regulation Authority (MHRA) have recently
completed a review of the risks of taking epilepsy medicines in pregnancy. This is a summary
of their key findings.

Medicines containing sodium valproate

Taking epilepsy medicines containing sodium valproate or valproic acid (brand names Epilim,
Depakote, Convulex, Episenta, Epival, Kentlim, Syonell, Orlept and Valpal) can cause serious
harm to an unborn baby.

Latest figures suggest that if 100 women take valproate medicines during their pregnancy,
about 10 of the babies will be born with physical birth abnormalities. This compares with 2 to
3 out of 100 in the general population.

About 30 to 40 of the 100 children will go on to have lifelong difficulties with learning and
thinking abilities, including autism (also called neurodevelopmental disorders).

Due to the serious harms, the valproate pregnancy prevention programme (‘prevent’) aims
to reduce and eventually stop the use of valproate during pregnancy. There are also
restrictions to how valproate can be used in girls and women who might become pregnant.

If you are pregnant or planning a pregnancy and you take valproate, seek advice from your
doctor and do not stop taking your medicine
For up-to-date information about valproate for women who could become pregnant, visit
our webpage or call the Epilepsy Action Helpline on 0808 800 5050.

Other epilepsy medicines

Lamotrigine (brand name Lamictal) and levetiracetam (brand name Keppra) are safer to use
during pregnancy than other epilepsy medicines. Information shows that they do not
increase the risk of physical birth abnormalities compared with the general population.
There is less information about whether taking these medicines in pregnancy causes
learning or thinking difficulties in children. The limited information available does not
suggest an increased risk compared to the general population, but the possibility of an
increased risk cannot be ruled out.
Carbamazepine, phenobarbital, phenytoin or topiramate use during pregnancy increases the
risk of physical birth abnormalities compared with the general population.
Risk of having a baby born with a physical birth abnormality
General population 2 to 3 out of 100 babies
Carbamazepine 4 to 5 out of 100 babies
Phenobarbital 6 to 7 out of 100 babies
Phenytoin about 6 out of 100 babies
Topiramate 4 to 5 out of 100 babies
Valproate about 10 out of 100 babies
Phenobarbital or phenytoin taken during pregnancy also increases the risk the child may
have difficulties with learning and thinking ability. Although the exact risk is not known, it is
not as high as for valproate.
Phenobarbital, topiramate, or zonisamide taken during pregnancy also increase the risk of
the baby being born smaller than expected compared with the general population.
For some of the epilepsy medicines there is not enough information about their use in
pregnancy to allow conclusions on their safety. There is some very limited information for
these other drugs:

Gabapentin and pregabalin – the risks of taking these during pregnancy are not yet fully
understood. Some research suggests that taking pregabalin during pregnancy may slightly
increase the risk of a baby being born with physical birth abnormalities.
Zonisamide – more research is needed to understand whether taking zonisamide during
pregnancy increases the risk of having a baby with a birth abnormality or a learning or
thinking disability.
Clobazam – some research suggests that clobazam may slightly increase the risk of a baby
being born with physical birth abnormalities. However, the research that is available does
not allow firm conclusions to be reached. So, the risk of harming a baby cannot be
confirmed or ruled out.
For the medicines listed below there is not enough information on their use in pregnancy to
make any conclusions about their safety when used during pregnancy. This means the risk of
harming a baby cannot be confirmed or ruled out:

Brivaracetam
Clonazepam
Eslicarbazepine
Ethosuximide
Lacosamide
Perampanel
Primidone
Rufinamide
Tiagabine
Vigabatrin
UK Epilepsy and Pregnancy Register
The UK Epilepsy and Pregnancy Register was set up to find out more about having epilepsy
and taking epilepsy medicines during pregnancy. If you have epilepsy and are pregnant, the
register would be delighted to hear from you.

Website: epilepsyandpregnancy.co.uk
Tel: 0800 389 1248
Quadruple screen test
The quadruple screen test is a blood test done during pregnancy to determine whether the
baby is at risk for certain birth defects.

This test is most often done between the 15th and 22nd weeks of the pregnancy. It is most
accurate between the 16th and 18th weeks.

A blood sample is taken and sent to the lab for testing.

The test measures levels of 4 pregnancy hormones:

Alpha-fetoprotein (AFP), a protein produced by the baby

Human chorionic gonadotropin (hCG), a hormone produced in the placenta
Unconjugated estriol (uE3), a form of the hormone estrogen produced in the fetus and the
placenta
Inhibin A, a hormone released by the placenta
If the test does not measure levels of inhibin A, it is called the triple screen test.

To determine the chance of your baby having a birth defect, the test also factors in:

Your age
Your ethnic background
Your weight
Your baby's gestational age (measured in weeks from the day of your last period to the
current date)

Often, positive screen results might cause you to consider other testing, such as:

Prenatal cell-free DNA screening. This sophisticated blood test examines cell-free DNA from
the placenta and the fetus in the mother's bloodstream. It evaluates whether your baby is at
risk of Down syndrome, extra sequences of chromosome 13 (trisomy 13), extra sequences of
chromosome 18 (trisomy 18) or a sex chromosome abnormality, such as Turner syndrome. A
normal result might eliminate the need for an invasive prenatal diagnostic test.
Targeted ultrasound. If you're at high risk of a neural tube defect, your health care provider
might suggest this test. Ultrasound isn't an effective screening tool for Down syndrome.
Chorionic villus sampling (CVS). This procedure can be used to diagnose chromosomal
conditions, such as Down syndrome. During CVS, a sample of tissue from the placenta is
removed for testing. CVS poses a slight risk of miscarriage and isn't useful in detecting
neural tube defects, such as spina bifida.
Amniocentesis. Amniocentesis can be used to diagnose both chromosomal conditions and
neural tube defects. During amniocentesis, a sample of amniotic fluid is removed from the
uterus for testing. Like CVS, amniocentesis poses a slight risk of miscarriage.
Your health care provider or a genetic counselor will help you understand your test results
and what the results might mean for your pregnancy.