Epilepsy: Antiseizure Medications & Birth Defects

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Do antiseizure medications cause birth defects?

This is a great question with a complicated answer. In the general population (meaning those who do not have epilepsy) birth defects occur in 2-3% of all pregnancies. However, when you have epilepsy, planning with your partner and your neurologist plays an important role to ensure a safe and healthy pregnancy. Planning is important because although most individuals who use medication to treat their epilepsy will have healthy pregnancies, there is still a risk.

Why is there still a risk?

Anytime a person (with or without epilepsy) takes a medication or drug prescribed at a high dose, there is a risk for birth defects. The risk for birth defects varies based on several different factors such as the number of medications prescribed and amount of each medication prescribed to treat the epilepsy. It is important to mention that most people who take antiseizure medication to manage their epilepsy will have healthy children without birth defects. 

Information about Specific Medications

Below is a table that contains information about commonly used antiseizure medications and their associated risk for birth defects. Although you may find the information below helpful, it is still very important to have a conversation with your health care provider about your specific medication(s) and risk factors. Your health care provider knows you, your body, and your medications best!

Remember: Birth defects occur in 2 to 3 out of every 100 pregnancies (2-3%) among people WITHOUT epilepsy — that’s the general population.

Antiseizure medication Risk of major birth defects
Valproic acid (also known as Depakote, Depakene, Valproate, Divalproex Sodium) 10 out of 100 pregnancies (10%) **
Also associated with a risk of autism and worse cognitive function in children exposed during pregnancy.
Carbamazepine (also known as Tegretol) 5 to 6 out of 100 pregnancies (5-6%)
Topiramate (also known as Topamax) 4 out of 100 pregnancies (4%)
Oxcarbazepine (also known as Trileptal) 3 out of 100 pregnancies (3%)*
Lamotrigine (also known as Lamictal) 3 out of 100 pregnancies (3%)*
However, daily dose of 325mg or more may be associated with increased risk of birth defects.
Levetiracetam (also known as Keppra) 3 out of 100 pregnancies (3%)*

* This degree of risk is similar to the general population without epilepsy.
** Valproic acid (also known as Depakote, Depakene, Valproate, or Divalproex Sodium) has been associated with the highest risk of birth defects among antiseizure medications.

I am worried; can I just stop taking my antiseizure medication?

Even if you find out that you are pregnant, it’s important to continue taking your antiseizure medication at least until you talk to your doctors (including your neurologist) for further guidance. Taking daily medication might be the safest option for you during pregnancy because seizures can also be harmful to you and the pregnancy.

What is the best way to ensure a healthy pregnancy for my unborn child and myself?

The best way to ensure a healthy pregnancy is by developing a plan before you become pregnant. Your planning committee should include your partner, neurologist, OB/GYN, primary care provider, and most importantly you! During the planning period, your neurologist may make some medication adjustments. If medication adjustments are recommended, your health care provider will explain and (likely) implement them before you become pregnant to ensure that the epilepsy is well controlled. Having a well-constructed plan can help reduce the risk of birth defects and ensure that both you and your child stay healthy.

If you become pregnant unexpectedly, call your neurologist and your other doctors (primary care physician, OB/GYN) right away. Continue to take your antiseizure medications as directed until you can speak to your doctors.