Is it safe to continue seizure medicines during pregnancy?

Question

Hello doctor,

I am a 28-year-old woman, recently found out that I am six weeks pregnant. I have been diagnosed with epilepsy and have been taking Carbamazepine 400 mg twice daily for the past five years. My last seizure occurred about eight months ago, and since then, my condition has been well controlled.

I am extremely worried about the effect of this medication on my baby. My neurologist advised me not to stop the medicine suddenly, but also mentioned that some seizure medications can increase the risk of birth defects, which has made me very anxious.

I have not yet informed my family because I feel confused and scared. I also read online that Folic acid is important before and during pregnancy, but I was not taking it before conceiving, which worries me even more.

My seizures are usually triggered by stress and lack of sleep, and currently, I am already struggling with poor sleep due to morning sickness. To make things more difficult, my husband wants me to stop all medications because he is concerned about the baby, but I know that stopping suddenly can be dangerous for both me and the pregnancy.

I would like to know:

Can epilepsy worsen during pregnancy?
Is Carbamazepine safe to continue in early pregnancy?
Which anti-seizure medicines are considered safest during pregnancy?
And most importantly, will my baby be healthy and normal if I continue treatment?

I am feeling very anxious and would really appreciate guidance on what the safest next step is for my baby and me.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query.

I completely understand your worries, and it is natural to feel anxious when you are pregnant and living with epilepsy (a medical condition in which a person gets repeated seizures or fits). Yes, if seizures are not well-controlled during pregnancy, they can affect the baby, because repeated seizure attacks may reduce oxygen supply and increase the risk of complications.

All women taking antiepileptic drugs (AEDs) (which means medicines used to control seizures) are advised to take Folic acid 5 mg per day. Folic acid is a vitamin that helps in the proper development of the baby’s brain and spine. It should ideally be started before pregnancy and continued at least until the end of the first trimester (the first three months), as it reduces the risk of major congenital malformations (birth defects present from birth).

Folic acid may also reduce the risk of cognitive deficits, which means problems with learning, memory, or thinking in the child.

Early pregnancy is also a good time to screen for structural abnormalities, meaning problems in the physical formation of the baby’s organs. A fetal anomaly scan done at 18 to 20 weeks of pregnancy is a detailed ultrasound that checks for major heart defects and neural tube defects (problems in brain and spinal cord development).

Women with epilepsy (WWE) should know that Sodium valproate has higher risks for the baby’s brain development. However, current evidence shows that Carbamazepine and Lamotrigine are relatively safer, and most babies exposed to them develop normally.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.