Safer epilepsy medicines in pregnancy

Published: February 14 2022
Last updated: May 12 2023

Over the last 20 years, there has been an increase in the use of epilepsy medicines known to be safer in pregnancy among pregnant women. This is according to a new study from the Netherlands, published in the journal Epilepsy & Behavior.

Sodium valproate is one epilepsy medicine known to carry a risk of physical and developmental problems in babies exposed to it during pregnancy. In January 2021, the Medicines and Healthcare products Regulatory Agency (MHRA) also reviewed the safety data of 10 of the most commonly prescribed epilepsy medicines.

The review found that four other epilepsy medicines (carbamazepine, phenobarbital, phenytoin and topiramate) also carried a risk to babies if taken during pregnancy. Lamotrigine and levetiracetam were found to be safer than other epilepsy medicines, but the MHRA could not make any conclusions about a further 11 epilepsy medicines due to lack of data.

In the Netherlands research, study authors Eline Houben and her colleagues used population-based data to assess trends in use of epilepsy medicines in pregnant women in the country between 1999 and 2019. They also cross-referenced the information with the safety profile of the epilepsy medicines.

During the study period, the researchers found 2,405 pregnancies exposed to an epilepsy medicine. They found that there was a significant increase in the use of known safer-in-pregnancy epilepsy medicines. However, there was also increased use of newer epilepsy medicines with uncertain risk in pregnancy. They found the use of epilepsy medicines with higher risk in pregnancy had decreased, except for topiramate. They also found that switching to safer epilepsy medicines before or during pregnancy was uncommon.

The researchers explained that the overall trends were very similar to those observed in other countries. A UK report by Michael Kinney and colleagues, published in the Journal of Neurology, Neurosurgery & Psychiatry in 2018, also looked at shifting trends in epilepsy medicine prescriptions in women with epilepsy. The data came from the UK and Ireland Epilepsy and Pregnancy Register between 1996 and 2016. Of 9,247 pregnancies, the team saw a significant increase in the use of lamotrigine and levetiracetam in the pregnant women, and a reduction in valproate and carbamazepine.

However, the UK researchers also looked at the rate of problems with babies at birth, and found that this did not significantly reduce in the 20-year time period. They said their research needs to be replicated on a larger scale in order to better understand these trends.

The Netherlands study authors also concluded by calling for more research on an international scale to increase understanding around the risks of epilepsy medicines in pregnancy and improve care for women.

There is more information about epilepsy and pregnancy here

If you are worried about your epilepsy medicines and pregnancy, please speak to your epilepsy specialist. It’s important to keep taking your medicines as prescribed, as stopping them could result in more frequent or severe seizures which could put you and your baby at risk.