Study Suggests Safe Pregnancy Outcomes Possible on Anti-seizure Medication

For a person with epilepsy, pregnancy can be a confusing time. Historically, essential anti-seizure medications were linked to birth defects in offspring, both physically and mentally. In some instances, they still can be. 

However, a new study published in JAMA Neurology has revealed that newer generation anti-seizure medications have a much lesser impact on the outcomes of children. Furthermore, evidence exists to suggest the addition of folic acid supplements can lower the risk of poor outcomes even further.

Taking medication throughout pregnancy is often essential to prevent seizures, which can be even more harmful to both the mother and her unborn baby than the medications. Therefore, never stop or alter your anti-seizure medication without consultation with an experienced physician. 

About the Study

The Maternal Outcomes and Neurodevelopment Effects of Antiepileptic Drugs (MONEAD) study is monitoring the outcomes of children from birth to six years of age with this most recent publication revealing outcomes of the 2-year-old assessments. 

It shows that at age 2, no cognitive or language development differences exist between children of medicated epileptic mothers and children of non-epileptic mothers. There were mild differences in motor development (physical movement) and general adaptive development (daily functioning) in children exposed to maximum doses of anti-seizure medication in the third trimester. The majority of women in this study were taking either lamotrigine or levetiracetam.

The current preliminary findings are promising but not conclusive about the long-term effects of anti-seizure medication exposure in pregnancy. Long-term outcomes cannot be determined until children reach approximately 6 years of age when learning and adult cognitive function can be more accurately predicted. 

Which Anti-seizure Medications are Safest in Pregnancy?

Kimford J. Meador, MD, lead researcher and professor of neurology at Standford University, explains that older generation anti-seizure medications, if taken in pregnancy, may cause physical malformations as well as poor cognitive and behavioral outcomes in children.

These older generation medications include valproate, phenobarbital, phenytoin, and topiramate, which all carry intermediate to high risk of either malformation, cognitive development difficulties, or both.

“The safest anti-seizure meds for both malformations and cognitive/behavioral problems are lamotrigine or levetiracetam,” advises Dr. Meador. “Carbamazepine also appears safe for both.” 

Although medications exist that are even newer than lamotrigine and levetiracetam, the data isn't available yet to know if they are safe in pregnancy. “There are over 30 antiseizure meds but we know the pregnancy risks for only a minority,” reports Dr. Meador. “Thus, more research is critically needed as the few that we know are safe do not always work.”

Why You Shouldn't Stop Your Anti-Seizure Medication

Even if you are taking older generation anti-seizure medications, don’t stop taking your medication without consulting a healthcare provider who knows your individual circumstances. As the pregnant body changes, your medication needs can also change. 

Kaarkuzhali Babu Krishnamurthy, MD, a neurologist specializing in epilepsy in pregnancy, explains that the pregnant body can break down and eliminate (metabolize) medication faster, leaving less available in the body to control seizures.  

“If however, as a seizure physician, we increase medication appropriately to keep the blood level of the medicine the same as it was before that woman was pregnant, her risk of seizures diminishes dramatically,” explains Dr. Krishnamurthy.

Regular blood tests should be taken in pregnancy to ensure levels of anti-seizure medications are maintained in the pregnant body. Depending on how your body responds, you may need to decrease, increase, or change your medications entirely. But these actions should always be guided by your healthcare team.

“Women should not lower their dose during pregnancy or even outside of pregnancy on their own without the doctor’s advice,” advises Dr. Meador. “Lowering the dose during pregnancy can be dangerous to both the mother and the fetus because it could result in seizures.”

Seizures vs Medication: The Risks of Both

Although some types of anti-seizure medication carry risks to the unborn baby, seizures also carry a risk to both mother and baby. 

Dr. Krishnamurthy says that a seizure in pregnancy involves a risk of direct harm to the fetus, maternal bleeding, miscarriage, and risks to the mother’s health. “If you add up statistically, all of those risks, it is estimated that the risk of some type of harm occurring either to the mother or to the fetus from a single seizure may be as high as 20% per seizure,” she explains. 

Anti-seizure medications carry the risk of both physical malformations and cognitive or developmental challenges. Dr. Krishnamurthy says the risk of malformations with older-generation drugs is about 6–10% while the risk with newer medications is about 4%.

Cognitive and developmental outcomes are being studied in the MONEAD study, which so far suggests that children are developing normally even when exposed to newer anti-seizure medications in pregnancy.

“Women with epilepsy have a very good chance of normal pregnancy outcomes if they avoid the drugs with the highest risks, and if they work with their doctor,” reassures Dr. Meador.

Talk to Your Healthcare Professional Early

Even if you are not planning a pregnancy, it’s still advisable to talk to your healthcare team about the safety of anti-seizure medications. “Women with epilepsy should talk with their physician well before pregnancy about the best medicine to use for their seizures and for possible future pregnancy,” advises Dr. Meador. 

In addition to discussing the safety of your medications, taking a folic acid supplement may protect against any damaging effects of the anti-seizure medications. When taken around the time of conception, folic acid (and folate) has been shown to improve language and intelligence scores in offspring of women taking anti-seizure medication in pregnancy.

“Even for women who inadvertently or unexpectedly get pregnant on an older medication, the fact that they have been supplemented with folic acid may help to reduce the likelihood of certain birth defects,” reports Dr. Krishnamurthy. 

Before you even start trying for a baby, be proactive in finding quality information about epilepsy and pregnancy. “To people who have a uterus, however they gender identify, be aggressive about getting this information,” advises Dr. Krishnamurthy. “Ask questions, talk to your doctor, find an obstetrician who's comfortable managing pregnancies in people with epilepsy.” 

With pregnancy counseling and support, regular blood tests in pregnancy, folic acid supplementation, and medical guidance, Dr. Krishnamurthy says, "the likelihood...of a woman, having a normal pregnancy, healthy pregnancy, seizure-free good delivery, [and] healthy baby is over 90%.”

A Word From Verywell

Anti-seizure medications are sometimes prescribed for mental health conditions and pain management in people without epilepsy. Therefore, regardless of your condition, it’s a good idea to talk to your healthcare team about the safety of your medications in pregnancy.