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If you’re pregnant or thinking of becoming pregnant, you can safely take anti-seizure medication. You may need to switch to another type of medication, however. Some epilepsy drugs increase the risk of congenital disabilities and other problems, like autism.

You may also need to increase the dosage of your epilepsy medications when you’re pregnant. That’s because your body may absorb anti-seizure medication differently in pregnancy.

What Anti-Seizure Medication Is Safe During Pregnancy?

The two safest anti-seizure medications for pregnancy are:

• Lamotrigine (sold under the brand name Lamictal^®).
• Levetiracetam (sold under the brand name Keppra^®).

Studies show these two therapies — whether taken alone or together in pregnancy — don’t raise the risk of congenital disabilities. Plus, there’s no link between average doses of these drugs in pregnancy and learning problems or autism in children.

However, one UPMC study linked high doses of Keppra in the third trimester with weaker language and verbal skills at age 3.

The Epilepsy & Pregnancy Medical Consortium (EPMC) suggests you talk to your doctor one year before becoming pregnant. If you need to switch medications, your doctor can start you on a new medication while gradually lowering the dose of your current medication.

Planning ahead also gives your doctor time to ensure the new medication controls your seizures. If one therapy that’s safer for pregnancy doesn’t control your seizures, you have time to switch to another one before pregnancy. You don’t have to worry about seizures affecting your pregnancy.

What About Other Anti-Seizure Medications?

Some anti-seizure medications may increase the risk of congenital disabilities, including heart problems, cleft lip, and spina bifida. They can also increase the risk of autism and cognitive problems later in life. This increased risk can range from very low to very high, depending on the medicine and its dose.

For example, taking valproate in pregnancy means your child has 13 times the risk of having spina bifida at birth. Taking carbamazepine in pregnancy increases this risk by about 2.6 times, based on a review in the journal Continuum.

Epilepsy drugs that slightly increase risks to the fetus include:

• Carbamazepine (sold under the brand names Tegretol XR^®, Equetro^®, and Tegretol^®).
• Oxcarbazepine (sold under the brand names Trileptal^® and Oxtellar XR^®).
• Zonisamide (sold under the brand name Zonegran^®).

Drugs that modestly increase the risk to the fetus include:

• Phenytoin (sold under the names Phenytek^®, Dilantin Infatabs^®, and Dilantin Kapseal^®).
• Phenobarbital (sold under the names Luminal^®, Solfoton^®, and Tedral^®).
• Topiramate (sold under the names Trokendi XR^®, Qudexy XR^®, and Topamax^®).

The anti-seizure drug with the highest risk to the fetus is:

• Valproic acid or valproate (sold under the names Belvo^®, Depakote^®, Dyzantil^®, Convulex^®, and Syonell^®).

There isn’t enough data to say whether the following medications pose risks to fetuses:

• Brivaracetam (sold under Briviact^®).
• Cenobamate (sold under Xcopri^®).
• Eslicarbazepine (sold under Aptiom^®).
• Ethosuximide (sold under Zarontin^®).
• Lacosamide (sold under Vimpat^®).
• Perampanel (sold under Fycompa^®).
• Clobazam (sold under Onfi^®).

How Are Seizures Treated in Pregnancy?

You should ideally talk to your doctor before getting pregnant about whether you need to switch your anti-seizure medication. If you are planning to become pregnant, if possible try to discuss this about a year beforehand, as it may take time to switch your medication. Your doctor also may suggest reducing the number of anti-seizure medications you take to reduce your risks of complications. However, it is important to note that should you become pregnant sooner or if you have an unplanned pregnancy, please let your doctor know so they can address possible medication changes.

If you’re on valproate or valproic acid, doctors recommend switching to another medication before you get pregnant. This helps to reduce the risk of congenital disabilities. If you’re taking valproate or valproic acid and find out you’re pregnant, talk to your doctor about switching right away.

If you’re on a drug that slightly or modestly increases risks to your fetus, your doctor may suggest switching to another medication before pregnancy. They may recommend lamotrigine or levetiracetam (or both) because these don’t increase the risk of congenital disabilities. However, these medications aren’t a good option if they don’t control your seizures.

Both anti-seizure medications and seizures pose risks to the fetus. Seizures in pregnancy could also pose risks to your health. When choosing the best epilepsy treatment for you in pregnancy, doctors need to balance these risks.

Your doctor may suggest staying on a drug, even if it slightly increases the risk of congenital disabilities or cognitive problems. That’s because the alternative of having seizures during pregnancy could be worse for your health, your baby’s health, or both.

What are the risks of seizures in pregnancy?

Tonic-clonic (generalized) seizures can cause miscarriage and stillbirth. They also increase the risk of preterm birth and low birth weight.

Focal seizures may temporarily slow down the fetal heart rate but aren’t likely to cause long-term issues. That said, if you have a focal seizure that affects awareness, you could injure yourself and put your fetus at risk of injury, too.

Monitor yourself for warning signs of seizures and let your ob-gyn and epilepsy doctor know if you have one.

Monitoring Anti-Seizure Medication Before, During, and After Pregnancy

If you’re pregnant with epilepsy, your doctor will need to routinely check the level of anti-seizure medication in your blood.

Your doctor will want the level of medication in your blood to stay about the same before, throughout, and after pregnancy. So, you should ask your doctor to check your medication levels before you get pregnant. If you did not get pregnant intentionally, get this test as soon as possible.

Your doctor should check your blood medication level every four weeks throughout your pregnancy. They should check your levels around the same time of day to ensure accuracy.

Drug levels require a simple blood test. If you’re taking more than one epilepsy medication, your doctor will check the levels of each one.

Pregnancy can reduce how much medication your body absorbs and how long medication stays in your blood. If the level of anti-seizure medication in your blood drops too low, your doctor will increase your dose. Your doctor may need to increase your dose more than once during pregnancy.

Even if your blood levels stay the same, your doctor may need to increase your dose if you have more seizures in pregnancy.

Anti-seizure medication after pregnancy

If doctors increase your dose during pregnancy, they’ll need to reduce it after pregnancy. They should taper your medication starting about three weeks after birth, says the EPMC.

Otherwise, your dose will be too high. If your dose of anti-seizure medication is too high, you may notice:

• Balance and coordination problems.
• Blurry or double vision.
• Dizziness.
• Vomiting.

If you have these symptoms during the postpartum period, contact your doctor right away. Call 911 or go to the nearest emergency department if your symptoms are severe.

Contact the UPMC Comprehensive Epilepsy Center if you are pregnant or considering becoming pregnant and have epilepsy or another seizure disorder.