I am 8 weeks pregnant. Can Lamotrigine harm my baby?

Question

Hello doctor,

I am 28 years old and just found out that I have epilepsy after having my first seizure six weeks ago at work. It was so embarrassing because I fell, hit my head, and everyone saw me shaking on the floor. I woke up in the ambulance with no memory of what had happened.

My EEG showed spike waves in the left temporal lobe, and the neurologist started me on Lamotrigine 100 mg twice daily. But here is my problem: I just found out I am eight weeks pregnant, and I am terrified that the epilepsy medication will hurt my baby. My OB says Lamotrigine is one of the safer options, but I have read online about possible birth defects, and I am panicking.

I had another smaller seizure last week, even while taking the medication, and I am scared to increase the dose during pregnancy. My folic acid level is only 3.2, and the doctor wants it higher to help prevent problems with the baby.

There is a family history of epilepsy; my aunt had it, but she never had children, so I do not know if it is genetic. This pregnancy was planned before my epilepsy diagnosis, and now I do not know what to do. Can seizures hurt the baby? Is it safe to continue epilepsy treatment during pregnancy?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Yes, uncontrolled seizures or an increase in seizure frequency during pregnancy can affect the baby. All women taking antiepileptic drugs (AEDs) should be advised to take 5 mg of folic acid daily before conception and to continue taking it until at least the end of the first trimester to reduce the risk of major congenital malformations.

Pre-pregnancy folic acid supplementation at 5 mg/day may also help reduce the risk of AED-related cognitive deficits in the child. Early pregnancy provides an important opportunity to screen for structural abnormalities. A fetal anomaly scan performed between 18 weeks 0 days and 20 weeks six days of gestation can help identify major cardiac defects as well as neural tube defects.

Women with epilepsy (WWE) and their partners should be informed about the possible adverse effects on the long-term neurodevelopment of the child following in utero exposure to Sodium valproate. Based on limited evidence, in utero exposure to Carbamazepine or Lamotrigine does not appear to adversely affect the neurodevelopment of the offspring. There is very little evidence regarding the effects of Levetiracetam and Phenytoin.

However, Sodium valproate has been strongly associated with an increased risk of neural tube defects and congenital heart defects in the baby.

I hope this helps.

Please follow up if you have any further concerns.

Thank you.