New research means doctors can use evidence-based dosing strategies for epilepsy medications in pregnant and postpartum women with epilepsy.
Research published in Neurology in January 2026 analysed dosing changes made in pregnant and postpartum women in the US between 2012-2016.
Dr Page Pennell and her colleagues used data from the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD).
She said: “Our goal was to generate practical evidence that empowers clinicians everywhere – from rural hospitals to urban subspecialty centres – to provide the best possible care for women with epilepsy during pregnancy.
“These strategies are based on real-world data from hundreds of successful pregnancies and can be applied in the clinic immediately.”
The findings are especially important, as the MBRRACE report into maternal deaths, published in 2025, showed that epilepsy and stroke were among the top five leading causes of maternal death between 2021-23.
A previous MBRRACE report from 2023, showed that deaths from sudden unexpected death in epilepsy (SUDEP) in mothers with epilepsy had doubled between 2013-15 and 2019-2021.
Epilepsy Action says there is a higher risk of death during pregnancy or 12 months after giving birth in people with epilepsy compared to those without.
Successful strategies
The Neurology study included a total of 299 women aged 14-45. It looked at their medication doses and seizures in pregnancy and six weeks after giving birth.
Around two thirds of epilepsy medications (67.8%) were increased during pregnancy. Just under half of medications (47.9%) were decreased again after the women had given birth.
Lamotrigine doses taken by the women were increased in pregnancy in nearly nine in 10 cases, (87.7%), to close to double the original dose they were taking at conception (191%), on average. By six weeks after birth, most of them (70.5%) had had their dose reduced to just over what it was originally (116% on average).
For those taking levetiracetam, more than half (56%) had their dose increased in pregnancy, reaching, on average, 177% of their original dose. By six weeks postpartum, around a third (34.4) had had their dose reduced to around 136% of the original.
The researchers concluded that these medication management strategies are why previous MONEAD studies showed no difference in seizure control between the pregnant and not pregnant groups. They added that “these findings can be useful for the management of pregnant women with epilepsy”.
Tom Shillito, health improvement and research manager at Epilepsy Action, said: “This research highlights how important it is to carefully manage epilepsy during pregnancy. Changes in the body can affect how medications work, so regular monitoring and adjustments can play a vital role in keeping women safe during pregnancy.
“We have been working with midwives, obstetricians and epilepsy specialist nurses, as well as people with epilepsy, to develop guidance to support healthcare professionals in providing the best possible care for pregnant women with epilepsy. This includes guidance on monitoring anti-seizure medicines during pregnancy and in the weeks after birth, when needs can change again.”
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