Pregnancy and antiseizure medicines

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HealthWiki > Epilepsy and Seizures > Chapter 7: Pregnancy and birth with epilepsy > Pregnancy and antiseizure medicines

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In this chapter:

 

In this chapter:

• Chapter 7: Pregnancy and birth with epilepsy
• Pregnancy and epilepsy
• Regular pregnancy checkups
• Pregnancy and antiseizure medicines
• Tiredness and nausea during pregnancy
• Pregnancy complications
• Labor and birth
• Breastfeeding for people with epilepsy
• Caring for your baby
• Birth control and antiseizure medicine
• Improving local epilepsy care for mothers

Some antiseizure medicines are safe to use during pregnancy and breastfeeding, and others are less safe. Some should not be used at all. But stopping antiseizure medicine increases the risk of seizures during pregnancy, making pregnancy more dangerous for both mother and baby. Talk to a health worker to make sure your antiseizure medicine is one that will have the least possible effect on your pregnancy and baby.

If a change in medicine needs to be made, try to do this before you get pregnant. Finding a medicine and dose that are safe and effective for you often takes 6 to 12 months, and sometimes longer. For more information about medicine safety and dose changes during pregnancy, see below.

No matter what medicine you use, the dose may need to be adjusted to keep up with how your body changes during pregnancy. For instance, changes in your hormones during pregnancy can affect the way your body responds to medicines. (Hormones are the chemicals your body makes to help control and support your body’s needs and your baby’s growth and development.)

If seizures are well-controlled with medicine before pregnancy, they are less likely to happen during pregnancy. If they do happen during pregnancy, adjusting the dose of your medicine may bring them back under control.

High doses of antiseizure medicines sometimes need to be reduced to prevent harm they might cause to the baby developing in the womb. People using more than 1 antiseizure medicine should review their medicines and doses with a health worker.

The change made us nervous. We talked regularly with the health workers during the weeks it took to change. Now we are pregnant with our second child. The dose change is working well again.

The clinic did blood tests to check my medicine levels when I was pregnant with my son. Because of my changing hormones and weight gain, I needed a higher dose. It worked! The dose change kept me from having seizures.

If you do change your medicine or dose, you and your health worker can decide if you should stay on the new medicine or dose after pregnancy or return to the medicine and dose you were taking before pregnancy. This decision will depend on how well your seizures were controlled both before and during pregnancy, side effects, and whether you plan to breastfeed (some medicines are safer for breastfeeding than others). Ask your health worker to help you with these decisions. See more information.

Safe use of antiseizure medicines during pregnancy

Some widely used antiseizure medicines increase the risk of physical disability in newborns and may cause developmental delays in growing children. The medicines valproic acid, carbamazepine, phenobarbital, phenytoin, and topiramate can affect the baby in the womb. The medicines lamotrigine and levetiracetam are safer during pregnancy, but they are not as widely available and may be more expensive. Other medicines considered safe are still being studied for their long-term effects.

It can be difficult to know what to do if the medicine you are using is not safe during pregnancy, but other, safer medicines are not affordable or not available where you live. Stopping medicine suddenly will probably cause you to have seizures, which may be dangerous for you and your baby. It may be safer to continue taking a less safe medicine than to have uncontrolled seizures while you are pregnant.

Talk to a midwife or other health worker about antiseizure medicines that are safe for pregnancy and what your options are.

Lamotrigine and Levetiracetam are the safest options during pregnancy. Their standard doses do not harm a baby’s development. These medicines may not be as readily available as other medicines.

Oxcarbazepine * can be used safely during pregnancy, but it is less well studied and may carry some risk for the baby, compared with lamotrigine and levetiracetam. Use at the lowest dose that controls seizures.

Carbamazepine has a higher risk to the developing baby than lamotrigine or levetiracetam, but it is widely available and may be necessary to use. Use the lowest dose that controls seizures. Avoid carbamazepine if safer options are available.

Phenobarbital and Phenytoin have a higher risk of developmental problems for babies. Avoid phenobarbital and phenytoin during pregnancy if safer options are available. Use only if they are the only options available that control seizures.

Valproic acid presents a high risk for developmental disorders to babies in the womb. Do not use during pregnancy. If it is the only option available that controls seizures, work very closely with a health worker who can talk with you about the risks to your baby and your health and watch your health closely during pregnancy. Do not stop taking medicine suddenly as this may cause seizures.

Find more information about antiseizure medicines in Chapter 4.

*(This medicine is not included in Chapter 4: Medicines for epilepsy and seizures, because it is not available in many communities Where it is available, this information is useful to know.)

How to choose an antiseizure medicine for pregnancy

• Find an available medicine that is safe for the developing baby.
• Make sure it controls the person’s seizures.
• Find the lowest dose that controls seizures.

If the medicine has already been controlling seizures (no seizures for 1 year), see if it can be slowly reduced to a lower effective dose to have the least possible effect on the baby’s development. Begin this process as early as 1 year before pregnancy or as soon as possible during pregnancy.

Changing or adjusting antiseizure medicine: How to decide

You may have concerns about changing a medicine or dose that works well to control your seizures. After all, the confidence and ease your medicine provides can help you avoid the stress and anxiety of an unexpected seizure. On the other hand, disabilities that antiseizure medicines might cause in a developing baby can be very serious.

I am not sure I should change my antiseizure medicine. The last time I tried, I had a seizure in the kitchen and got burned. That was awful! But I should do it for the baby. This is so confusing! I need help deciding…

If you are planning a pregnancy, give yourself enough time to find a midwife or other health worker who understands pregnancy and birth for people with epilepsy. If you are already pregnant, talk to your midwife or health worker about your concerns and ask questions that can help you make a decision you feel comfortable with.

Although changing or adjusting antiseizure medicine is your choice to make, getting support and advice during and after your decision-making process can be helpful. Epilepsy support groups are a good place to share your experience and concerns, and to learn from other people’s experience about the effects (good and bad) and risks of different medicines.

Since different medicines affect people differently, the advice you get from an epilepsy support group should not take the place of medical guidance from a health worker

Questions about pregnancy for people with epilepsy to ask a health worker

Is the antiseizure medicine I am taking safe for pregnancy? If my medicine is safe, will my dose need to be adjusted? If my medicine is not safe, what other medicines are available? How much time will I need to try a new medicine and get to the right dose? If I have seizures, will they harm the baby? What can I do to lessen any harm? How often do I need to see a health worker during pregnancy? When should I call or come to see you? What else should I be aware of to have a healthy pregnancy?

For the health worker. A person with epilepsy may be embarrassed or shy to talk about epilepsy. When you talk about pregnancy and birth to a person with epilepsy, show you are there to listen and help them, not to judge or criticize. This can help them feel safe sharing their worries and difficult choices. As they talk more, people often find they have the answers to their own problems. Encourage pregnant people with epilepsy or those trying to get pregnant to talk to other people with epilepsy who have children. This can help them learn from others’ experiences about being pregnant with epilepsy.

Questions for health workers to ask a pregnant person with epilepsy

When and how did you find out you have epilepsy? What medicine do you take for your seizures? How many seizures do you have in a day? a week? a month? How long have you been taking your antiseizure medicine? What side effects do you have from your antiseizure medicine? Have you had any seizures since becoming pregnant? Have you been pregnant before? Did you have seizures during your previous pregnancy? What questions or concerns do you have about your pregnancy and epilepsy?

Remember, all bodies are different, and decisions about your pregnancy are your own and must feel right for you!

This page was updated:24 May 2026