Can I take Lamotrigine for my epilepsy during pregnancy?

Question

Hello doctor,

I am 31 and have epilepsy and take Lamotrigine daily, which my neurologist says is lower risk, but I am still worried. I want to know if seizures during pregnancy could harm the baby directly. I want to know if there are folate strategies that help reduce the risk from the medication. I want to know if I should see a high-risk obstetrician early, even if my seizures are well-controlled.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You are taking the right steps by planning, as this can make a difference in both your health and your baby's safety. Let us address each concern clearly.

Uncontrolled seizures, especially generalized tonic-clonic seizures, can be dangerous during pregnancy.

Risks to the baby: Oxygen deprivation, fetal injury from maternal falls, preterm labor, or miscarriage in rare cases.
Risks to you: Trauma, loss of consciousness, and complications during delivery. With well-controlled epilepsy, especially while using Lamotrigine, most women have healthy pregnancies.

Lamotrigine is considered one of the safest antiepileptic medications during pregnancy. It has a low risk of major congenital malformations compared to older medications such as Valproate. Lamotrigine levels can drop during pregnancy, so blood level monitoring is advised.

Folic acid plays an important role in reducing the risk of neural tube defects.

Start before conception, ideally at least three months prior.
The suggested dose is 4 mg daily, which is higher than the standard 0.4 mg used by the general population.
Continue through the first trimester and often throughout pregnancy.
Discuss dosing with your neurologist or obstetrician, as some situations may require up to 5 mg.

Seeing a high-risk obstetrician early is advisable, even if epilepsy is well controlled.

They will coordinate care with your neurologist.
They will assist with fetal monitoring and growth assessments.
They will help plan delivery, noting that most individuals with epilepsy can have vaginal deliveries.

You are taking a positive and proactive role in planning for pregnancy, and this supports both your well-being and the baby’s safety.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.