Is epilepsy medicine safe during pregnancy planning?

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I understand your concerns and appreciate that you are planning a pregnancy carefully. It is strongly advised that you consult a consultant neurologist for detailed evaluation, guidance, and optimization of treatment before conception and throughout pregnancy.

Some antiepileptic drugs require special consideration during family planning. For example, Lamotrigine (an antiepileptic medicine commonly used to control seizures) can reduce the effectiveness of estrogen-containing contraceptives. For this reason, progesterone-based contraception, such as progesterone-form intrauterine contraceptive devices or oral progesterone preparations like tablet Primolut N, may be preferred when contraception is required. The usual dose of Primolut N is one tablet three times daily, as advised by a doctor.

Uncontrolled epilepsy (a neurological condition characterized by recurrent seizures due to abnormal electrical activity in the brain) can pose risks during pregnancy. If seizures are not well controlled, there is an increased risk to both the mother and the baby. Frequent seizures during pregnancy may affect fetal oxygen supply and increase the risk of complications. Therefore, maintaining good seizure control is extremely important.

All women taking antiepileptic drugs should be advised to take folic acid 5 mg per day prior to conception and continue it at least until the end of the first trimester. Folic acid (a B vitamin essential for neural development) helps reduce the risk of major congenital malformations, especially neural tube defects (birth defects affecting the brain and spinal cord). Pre-pregnancy folic acid at a dose of 5 mg per day may also help reduce the risk of antiepileptic drug–related cognitive deficits in the child.

Early pregnancy provides an important opportunity for screening fetal structural abnormalities. A detailed fetal anomaly scan performed between 18 weeks and 20 weeks and 6 days of gestation can detect major abnormalities, including neural tube defects and significant cardiac defects.

Women with epilepsy and their partners should be counseled regarding the possible long-term neurodevelopmental effects on the child following in utero exposure to certain antiepileptic drugs. Sodium Valproate (a potent antiepileptic drug) is known to have a high risk of causing neural tube defects, cardiac defects, and long-term neurodevelopmental problems, and its use during pregnancy should be avoided whenever possible.

Based on available evidence, in utero exposure to Carbamazepine and Lamotrigine does not appear to significantly affect the neurodevelopment of the child. There is currently limited evidence regarding the effects of Levetiracetam and Phenytoin, but available data suggest a relatively lower risk compared to Sodium Valproate. Because Sodium Valproate has a strong association with neural tube defects and congenital heart defects, it should only be used when no safer alternatives are effective.

With proper planning, appropriate medication selection, adequate folic acid supplementation, and close monitoring by a neurologist and obstetrician, most women with epilepsy can have a safe pregnancy and deliver a healthy baby.

I hope this helps you.

Kindly revert if there are any queries.

Thank you.