Women, Pregnancy, and Epilepsy
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:
- 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.
- Tegretol, Carbatrol, and 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. "This makes managing epilepsy during pregnancy very complicated," says Jacqueline French, MD, professor of neurology at New York University's Langone Medical Center and co-director of Epilepsy Research and Epilepsy Clinical Trials at the NYU Comprehensive Epilepsy Center. "It's important that women with epilepsy who want to become pregnant make sure they are seeing a doctor who keeps up to date on all the newest research. What we know about epilepsy and pregnancy literally changes from month to month." You can also check with the Epilepsy Foundation if you have questions.
Prepare in Advance for Pregnancy With Epilepsy
Depending on what your doctor says about your epilepsy, you may want to change medications before you get pregnant, or it might be fine to stay with the one you are taking now. If you are taking more than one antiseizure drug, your doctor may recommend that you taper down to just one. That's because combinations of drugs to treat epilepsy have a higher risk of causing birth defects than just one drug alone.
If you are making any changes in your antiseizure medications at all, you should do that at least a year before getting pregnant. Switching medications has risks, too. You may not respond well to the new drug and have breakthrough seizures, which could be harmful to a pregnancy. When changing medications, doctors will usually add the new drug before stopping the old one. If you become pregnant during this time, the baby could be exposed to both drugs instead of just one.
Whether you change seizure drugs or not, be sure to add folic acid to your daily schedule. Starting before you get pregnant, take prenatal vitamins with 0.4 milligrams of folic acid every day, and keep taking them throughout the pregnancy. Folic acid has been shown to reduce the risk of some birth defects by 60% to 70%. Because there are some extra risks associated with pregnancy when you have epilepsy, it's important to do everything you can to minimize those risks.