The safety of taking an anti-epileptic in pregnancy depends on the medication, the mother’s medical history, and factors like whether the mother needs additional drugs to manage other conditions. Overall, anti-epilepsy drugs are linked with a higher risk of birth defects, and some are worse than others. This risk should be balanced against the clear benefit of controlling epilepsy during pregnancy; if the mother experiences severe seizures, these could compromise the pregnancy, for example. Women with epilepsy who are pregnant or are planning to try for a baby can discuss the situation with an obstetrician and a neurologist for advice.
Concerns with using an anti-epileptic in pregnancy are centered on the first 18 weeks, when there can be a higher risk of congenital malformations, especially neural tube defects like those associated with spina bifida. Some research suggests that taking folic acid supplements can help with this problem, as can monitoring the mother’s blood carefully to check serum levels of the medication. At times, the concentration of the drug changes as a result of pregnancy-associated changes, in which case the risks of taking the drug can increase.
Carbamazepine is one of the safer anti-epileptics to use in pregnancy, and some neurologists also recommend valproic acid, although it can come with an increased risk of birth defects. Lamotrigine is also effective and can be used in some cases. Phenobarbital and phenytoin are generally not recommended because they are associated with a much higher risk of pregnancy complications, congenital abnormalities, and cognitive deficits in the child.
The bottom line is that any anti-epileptic is likely to increase the risks of birth defects when compared to the rest of the population, although the difference can be relatively slight. In a patient with severe epilepsy, however, the benefits of taking an anti-epileptic in pregnancy outweigh the risks in many cases, although a thorough evaluation may be recommended to confirm an epilepsy diagnosis and make sure the mother needs the medication. Using an anti-epileptic in pregnancy can prevent seizures that could threaten the life of mother, child, or both.
Women who decide to use an anti-epileptic in pregnancy may need to change medications to select the safest option, and could require monitoring to check for complications and assess serum levels. If they notice side effects, they should bring them up as soon as possible so they can be evaluated. In the event of pregnancy complications, birth defects, and other problems, mothers can report the problem to a drug database; some databases specifically record data on women with epilepsy to help determine which medications are safest, using information from women who had to use them during pregnancy.