Is Lamotrigine safe for my daughter during pregnancy?

Question

Hello doctor,

My 24-year-old daughter has had epilepsy since she was 16, and now she wants to get pregnant. I am worried. She has been taking Lamotrigine 200 milligrams twice daily and has been seizure-free for almost two years. Her neurologist said her medication dose might need to be adjusted during pregnancy, but she is scared of having breakthrough seizures.

She previously had tonic-clonic seizures and once experienced status epilepticus, which was very frightening. Her recent electroencephalogram (EEG) showed some background slowing but no active seizure activity. She has been taking Folic acid, five milligrams daily as recommended, but is concerned about birth defects from epilepsy medications. Her boyfriend is supportive but also worried about her ability to drive and work if her seizures return. The last time she had seizures, they were triggered by a lack of sleep and stress.

Can women with epilepsy have safe pregnancies, and what kind of monitoring is needed?
Should she switch medications before trying to conceive, or just adjust the current dose during pregnancy?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Women taking antiepileptic drugs have a slightly higher risk of birth defects. However, Lamotrigine and Levetiracetam are among the safest options, with a low risk of about 2%. Taking Folic acid before pregnancy helps reduce the chance of birth defects. The most common defects linked to these drugs include cleft lip and palate, neural tube defects, and some heart problems, but these can usually be detected early with an ultrasound during pregnancy. Careful planning is very important.

Pregnancy should be planned when seizures are well-controlled, and folic acid tablets should be taken regularly. It is crucial not to stop antiepileptic medicines without consulting a doctor, as these medications should be continued.

The neurologist will decide whether to adjust the dose or switch medications, but Lamotrigine is considered one of the safest drugs during pregnancy, with the lowest risk of birth defects. Pregnancy affects women with epilepsy differently; some may experience more seizures due to hormonal changes, while others may not. With proper medication and avoiding triggers like lack of sleep, a safe pregnancy is possible.

Fetal monitoring using ultrasound scans is essential, including a nuchal translucency scan at 12 weeks, an anomaly scan at 20 weeks, and a fetal echocardiogram at 24 weeks. These scans help detect most major birth defects early.

I hope you are satisfied with my answer.

For further queries, you can consult me at iCliniq.

Thank you.