Is it safe to take epilepsy drugs when pregnant?

Are my epilepsy drugs safe to take in pregnancy and could they harm my baby?

is-it-safe-to-take-epilepsy-drugs-when-pregnant_58678

In a nutshell

It will depend on your medication and your doctor will advise you.

Advertisement

The expert view

According to the Royal Society of Medicine, around 1,800-2,400 women with epilepsy have children each year, and the majority experience a normal pregnancy and birth.

But because some anti-epilepsy drugs can increase the risk of physical defects in a developing baby, doctors advise that you speak to a specialist if you are trying to become pregnant.

“If you have epilepsy and are either planning to conceive or are pregnant then do speak to your doctor as you will be monitored closely during your pregnancy,” says MFM’s GP Dr Philippa Kaye.

“The potential risk of the medications has to be balanced against the risk to you and your developing baby if you have seizures. Women on antiepileptic medication are generally advised to take a higher dose of folic acid than other pregnant women, 5mg instead of 400mcg.”

Your options 

The risks increase if epilepsy drugs are used during the first trimester and particularly if a mum-to-be takes two or more antiepileptic drugs. It may be possible to switch to safer drugs, reduce the total dose, or change the way the drugs are given.

It’s important to remember that the likelihood of a mum-to-be taking antiepileptic drugs having a baby with no problems is at least 90%. Therefore, unless they are advised to do so by their doctors, pregnant women should not stop taking essential treatment because of concerns for their baby. 

Guidance from NICE (the National Institute for Health and Care Excellence) covers a number of different epilepsy drugs.

Valproate

Valproate is associated with the highest risk of birth defects (especially neural tube defects such as spina bifida), and long-term neurodevelopmental defects.

From April 2018, pregnant women will not be prescribed valproate unless they’ve signed a form saying they understand the risks.

If you are currently taking valproate, you should see your GP to have your treatment reviewed. It’s not wise to stop taking it without medical advice. 

Carbamazepine

Carbamazepine carries the risk of neural tube defects, heart problems, hypospadias (issues with the urethra and penis) and microcephaly, which is a neurological defect that includes a small head.

The UK Teratology Information Service – which examines drugs and their effects in pregnancy – says that “when considering risk benefit balance during pregnancy, it is important to take into account the risks of maternal seizures, which can result in reduced placental perfusion (blood flow), fetal anoxia (lack of oxygen) and intrauterine death.”

Primidone

One of the main risks of primidone is cleft palate, while research has also found an increased risk of microcephaly and facial diseases in children born when their mums have taken primidone.

Phenobarbital

This can cause skull and face defects, as well as abnormalities of the fingers and, less commonly, cleft palate.

Folic acid taken before and during pregnancy can help reduce the risk of neural defects, while vitamin K is normally given to the mum and baby at birth to avoid haemmorhaging. 

Phenytoin

A study of around 60,000 children found there was 3.7 times more risk of a baby developing a birth defect if its mum was taking phenytoin 

Lamotrigine

This newer generation anti-epileptic drug has been the subject of Danish research which found there wasn’t a greatly increased risk of major birth defects compared to babies whose mums didn’t take the drug 

Topiramate

The NHS advises that topiramate carries an increased risk of cleft palate if taken in the first trimester of pregnancy, but in the same study with lamotrigine, researchers also concluded there wasn’t a significantly increased risk of major birth defects.

All pregnant women with epilepsy, whether taking medication or not, are encouraged to notify the UK Epilepsy and Pregnancy Register on 0800 389 1248.

Mums on our forum say

“Conception was fine but finding obstetricians who understand the implications of epilepsy on pregnancy and childbirth is a challenge. That’s where there’s a huge gap in support and information.” JER11

Advertisement

“I have just found out that i am pregnant at 6 weeks and am currently taking 600mg of Epilim (Sodium Valproate) each day. I have spoken to the specialist and she has said it will be more harmful to the baby to change the drug now as i am already pregnant.” AnR123

Comments ()

Please read our Chat guidelines.