Women, Pregnancy, and Epilepsy
Getting Pregnant With Epilepsy continued...
Unfortunately, some of the most common drugs for controlling seizures have been found to increase the risk of birth defects. In the general population there is a 2%-3% chance that a child will have a birth defect. In women with epilepsy, this risk goes up to 4%-8%.
To help decrease the chance of birth defects, especially neural tube defects that can affect the brain and spinal cord, women with epilepsy should take at least 0.4 milligrams per day of folic acidsupplements, before they try to conceive.
Epilepsy Drugs Safe for Pregnancy
Which epilepsy drug should you take? Unfortunately, there is no clear answer. There are no antiseizure drugs that are completely without risk of causing birth defects. But some antiseizure medications appear to be more dangerous for a developing baby than others, and your doctor may be able to avoid prescribing them. Here's what doctors know so far:
- Divalproex sodium (Depakote) and Depakene seem to carry the highest risk of damage to the baby, particularly neural tube defects, such as spina bifida.
- Doctors used to advise women to switch to phenobarbitol during pregnancy, because it appeared to be safer. Now, more recent research shows that it can also increase the risk of birth defects.
- Carbamazepine (Tegretol, Carbatrol), and lamotrigine (Lamictal) appear to carry lower risks of birth defects than Depakote and phenobarbitol.
But that's not the whole story. Research has recently shown that women taking Lamictal have a higher risk of breakthrough seizures during pregnancy. That's because metabolism of Lamictal -- as well as other antiepileptic drugs -- increases during pregnancy. This can cause a drop in the level of antiseizure medication in your system. If that level gets too low, you could have a seizure. But if your doctor prescribes a higher dose of Lamictal to make sure that you don't have breakthrough seizures, there could be a higher risk of damage to your baby.
What makes things a bit more confusing is that information about the safety of antiseizure drugs during pregnancy is changing all the time. As a result, managing epilepsy during pregnancy can be complicated. If you who want to become pregnant make sure you see a doctor who keeps up to date on all the newest research. You can also check with the Epilepsy Foundation if you have questions.