From the outset, it must be stated that all Anti-Seizure medications (ASMs) carry a certain amount of risk during pregnancy. It is important to state this from the outset, as it further highlights the importance of pre-conceptual planning (discussed in the ‘Planning for Pregnancy’ article within this section of our website).
Although the risk of your child having birth problems associated with your ASM are quite low, we believe it is very important that women with epilepsy have the most up to date information on potential risks associated with their particular medication.
It is also important to note that research on the potential impacts of ASMs during pregnancy is something that is being continually researched and advice is tailored accordingly on an individual basis. It is due to ongoing research that we are able to provide information to women with epilepsy about these potential risks.
In the general population, there is approximately a 2-3% risk of occurrence of birth defects that cannot always be predicted or prevented. This is slightly higher in the population of women with epilepsy.
Research has found that Anti-Seizure medications can cause specific problems for children exposed to ASMs in-utero. These come under three broad headings which are outlined below.
1) Neurodevelopmental problems
Neurodevelopment describes how a child develops skills such as speaking, understanding and behaving. Neurodevelopmental problems become more obvious over time, so you may not know about these problems until your child is a few years old.
2) Minor congenital abnormalities
Minor congenital abnormalities are birth problems that do not usually need any treatment. They include minor abnormalities of the fingers, toes or limbs. They also include specific facial features.
3) Major congenital abnormalities
Major congenital abnormalities (MCM) are birth problems that need treatment, usually with surgery. They include things like spina bifida, a hole in the heart, or a cleft palate (where the roof of the mouth is not correctly joined).
Known Anti-Seizure Medication Risks
This section will outline the current known risks associated with commonly used ASMs. However, we would again point out that the risk with each individual medication is quite low – apart from Sodium Valproate and Topirimate which have their own specific section at the end of this page.
Please note with the figures listed below, the data has been established on monotherapy treatment – i.e, where just one medication has been used in the treatment of a person’s epilepsy.
- Lamotrigine (brand name Lamictal), Levetiracetam ( brand name Keppra) and Oxcarbazepine (brand name Trileptal)
Studies to date have suggested that these medicines are safest to use during pregnancy than other epilepsy medicines with a prevalence of a MCM of 2-3%. Currently available information supports that they do not increase the risk of physical birth abnormalities compared with the general population. - Carbamazepine (brand name Tegretol)
The prevalence of MCM in children exposed in-utero to carbamazepine monotherapy is currently believed to be approximately 5%. Available evidence suggests that the risk is dose dependent. Study findings to date on the risk of neurodevelopmental disorders in children exposed to carbamazepine in-utero are contradictory, but a risk cannot be excluded.
For the majority of other medications, there is a lack of available evidence on the exact risk estimate – for your individual risk please speak with your epilepsy specialist team.
Sodium Valproate (brand name Epilim/Depakine)
With Sodium Valproate, the risk of both Major Congenital Malformations and Neurodevelopmental problems is much higher in comparison to other ASMs. There are very specific procedures around the prescribing and dispensing of Sodium Valproate which is collectively known as a Pregnancy Prevention Programme (PPP). The risks associated with Sodium Valproate and details of the PPP are outlined in a separate article within this section of our website. Visit the ‘Valproate (Epilim) Guidelines’ section to read more.
Topiramate (brand name Topamax)
Recent research established that the risks of Neurodevelopmental problems associated with Topiramate was much higher than originally thought. Children exposed to Topirimate during pregnancy have a higher risk for birth defects and may be smaller and weigh less than expected. They may also have a higher risk for autism spectrum disorders, intellectual disability, and attention deficit hyperactivity disorder. For this reason, there are very specific procedures around the prescribing and dispensing of Topiramate which is collectively known as a Pregnancy Prevention Programme (PPP). Details of the PPP are outlined in a seperate article within this section of our website. Visit the 'Topiramate (Topamax) Policy' section of our website to learn more.
IMPORTANT – PLEASE NOTE
It is advised that you speak with your epilepsy team at least 1 year prior to planning a pregnancy. Even where there is an established risk of exposure to certain ASMs during pregnancy, your medical team will work with you to mitigate these risks insofar as possible; this can be achieved by reducing doses or by potentially changing medication for treatment during pregnancy. This once again highlights the importance of pre-conceptual planning and having a discussion with your medical teams.
As noted at the outset of this section of our site, research in this area is constantly evolving. We will do out utmost to ensure that the most up to date information possible is included here.
The sources for the information above are taken from the Health Products Regulatory Authority website.
Summary
- DO NOT stop taking any ASM under any circumstances without first speaking to your medical team.
- All medications including anti-seizure medications carry a certain element of risk when used during pregnancy.
- The importance of pre-conceptual planning cannot be over emphasized. Epilepsy and pregnancy are both individual journeys – the best people to advise you on this are your medical team, who will also have the most up to date information on potential risks of ASMs.
- Research on this topic is ongoing.
- If you have any concerns on ASM exposure during pregnancy, seek counsel from your medical team immediately.