Are epilepsy medications safe during pregnancy?

Question

Hello doctor,

I am 28 years old, and my epilepsy has been out of control since I started trying to get pregnant six months ago. My neurologist switched me from Valproate ( medications used to treat epilepsy) to Lamotrigine (an antiepileptic drug) because of birth defect risks, but now I am having breakthrough seizures almost weekly. I had three tonic-clonic seizures last month, which never happened when I was on my old medication. My folic acid levels are good (8.2 ng/ml), but my Lamotrigine levels keep fluctuating between 3.1 and 7.8. The seizures always seem to happen right before my period starts, and my cycles have been irregular since the medication change. My husband is worried about me getting pregnant with uncontrolled epilepsy, but we want to start a family. also been having these weird partial seizures where I can not speak for like 30 seconds, which is scary when I am driving. What epilepsy medications are safest during pregnancy, and how can we get better seizure control?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

You are worried about the potential risks of congenital malformations in the fetuses of pregnant women with epilepsy (WWE) who are either exposed to or not exposed to antiepileptic drugs (AEDs)?

WWE planning to conceive should consult a clinician skilled in epilepsy management to guide them in making informed decisions regarding the selection and dosage of AEDs, taking into account the risks to the fetus and the necessity of seizure control.

It is important for WWE to know that the majority of mothers give birth to normal, healthy babies, and the likelihood of congenital malformations is low if they are not exposed to AEDs during the periconception period.

Women should be made aware that the risk of congenital abnormalities in the fetus is influenced by the specific type, quantity, and dosage of AEDs used.

According to limited evidence, exposure to Carbamazepine ( an anticonvulsant medication) and Lamotrigine (an antiepileptic drug) in utero does not seem to negatively impact the neurodevelopment of the child. There is minimal evidence available regarding levetiracetam and phenytoin. Parents should understand that the data on long-term outcomes is derived from a small cohort of children.

All women are recommended to take 5 milligrams per day of folic acid before conception and to maintain this intake at least until the end of the first trimester to help lower the risk of significant congenital malformations.

Taking 5 milligrams per day of folic acid before pregnancy may also assist in reducing the risk of cognitive deficits associated with AEDs.

I hope this information helps you.

Feel free to ask further queries.

Thank you.