Epilepsy medicines and pregnancy
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Key points
- Some epilepsy medicines may harm an unborn baby if taken during pregnancy
- Some epilepsy medicines have higher risks than others. There are special rules in place for sodium valproate and topiramate
- Ideally, it is best to discuss your epilepsy medicines with an epilepsy specialist before you get pregnant. Your GP can refer you for pre-conception counselling
- Do not stop taking your epilepsy medicines before getting medical advice. This can be dangerous
- Your epilepsy specialist might suggest changing your epilepsy medicines or changing the amount you take
- Sometimes the benefits of taking epilepsy medicine can outweigh the risk to your pregnancy
- Your epilepsy specialist or epilepsy specialist nurse (ESN) can help you understand the risks and benefits of your treatment options during pregnancy. They will work with you to find the safest treatment for you and your baby throughout your pregnancy
- We have more information pages about starting a family that can help support other areas of your pregnancy
Always get medical advice before making any changes to your epilepsy medicine.
Stopping your medicines suddenly can be harmful for you and your baby. It may make you have more seizures or seizures that are more severe.
Uncontrolled seizures can increase your risk of sudden unexplained death in epilepsy (SUDEP).
Will taking epilepsy medicines affect my baby?
Most people with epilepsy have healthy pregnancies and give birth to healthy babies. But some epilepsy medicines can cause problems for unborn babies if they’re taken during pregnancy. The chances of these problems happening are different for different medicines.
It is important to understand the risks and benefits of all your treatment options before you decide on your care during pregnancy.
You can find information about the risks of individual medicines below. You can then discuss this information with your epilepsy specialist or epilepsy specialist nurse (ESN).
There are extra rules for prescribing sodium valproate and topiramate. These medicines have higher risks. We have more information on our sodium valproate and topiramate pages.
Although there are risks, it’s important to keep taking your medicine until you have spoken to an epilepsy specialist or ESN. Uncontrolled seizures might be more dangerous for you and your baby.
What are the risks of taking epilepsy medicine during pregnancy?
Research focuses on these main areas:
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Complications for the newborn baby (birth defects)
These may happen when the baby doesn’t develop properly in the womb. They can include:
- Conditions like spina bifida. This is where the bones of the spine do not develop properly
- Problems with the face and skull. This can include cleft lip and palate, where there is a split in the upper lip or roof of the mouth. It happens if a baby’s face doesn’t fully join together in the womb
- Problems with the development of the hands and feet, heart, kidney, urinary tract or sexual organs
- Problems with how the eyes develop. This could cause issues with eyesight
- Hearing problems or deafness
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Effects on learning and thinking ability
Some medicines may affect a child’s learning and development. Possible effects include:
- Walking or talking later than other children of the same age
- Poor speech and language skills
- Memory problems
- Lower intelligence than other children of the same age
- Autism spectrum disorder or attention deficit hyperactivity disorder (ADHD)
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Growth in the womb
Some medicines may increase the risk of a baby being born smaller than expected.
Babies born with a low birth weight are more likely to become ill or have problems with learning and thinking.
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Withdrawal symptoms at birth
Some epilepsy medicines can pass from mother to baby during pregnancy. So babies may have withdrawal symptoms after they’re born because they aren’t getting the medicine this way anymore.
This is more likely to happen with some medicines than others. Your healthcare team can give you more information about possible withdrawal effects.
Your baby will be monitored closely if you take medicines where this may happen.
Your pregnancy and epilepsy checklist
There are things you can do if you’re planning a pregnancy:
- Ask your GP for a referral to an epilepsy specialist for preconception counselling
- Ask your epilepsy specialist or ESN for advice about getting pregnant
- Do you have all the information you need to make decisions about your epilepsy medicine?
- Do you know the benefits and risks of your treatment options?
- Do you need to be monitored as your pregnancy progresses?
- Start taking folic acid every day. Ideally, you should start taking this 3 months before you become pregnant, or as soon as you know you are pregnant. Be aware that folic acid may affect how some epilepsy medicines work. You can find more information about folic acid on our page about planning a baby
- Ask your GP to refer you to an epilepsy specialist as soon as you start thinking about becoming pregnant if you are taking sodium valproate or topiramate. You can find out more about these medicines on our topiramate and sodium valproate pages
- Ask about measuring the levels (concentration) of epilepsy medicine in your blood ahead of pregnancy. This is so you can see how the levels change before and during pregnancy. We have more information about this on our pregnancy and epilepsy page
- Go to all your antenatal appointments. This will help make sure you and your baby are well throughout your pregnancy
- Know what to do if you discover that you’re pregnant. This should include who to contact, and how to manage feeling and being sick to avoid losing seizure control during pregnancy
- If you have an unplanned pregnancy, keep taking your epilepsy medicines until you have spoken to your epilepsy specialist or ESN. Uncontrolled seizures could be dangerous for you and your baby
Maternity epilepsy toolkit
Women With Epilepsy has more information about planning and having a baby on their website. They have a toolkit to help you manage your epilepsy and pregnancy. It includes:
- Key contact details
- Guidance about what should happen at each stage of your pregnancy, including appointments and scans
- Questions that you can discuss with your healthcare professionals
- Space to record information about your epilepsy medicines
Which epilepsy medicine should I take?
The epilepsy medicine you take depends on the type of epilepsy and seizures you have, and your age. Your epilepsy specialist or ESN can help to decide which medicine is best for you.
Pre-conception counselling
You should be offered pre-conception counselling if you are planning to get pregnant. Your epilepsy specialist can review your epilepsy medicine and help you make changes if needed. They can also answer any questions you have. You can find out more about pre-conception counselling on our page about planning a baby.
If you are already pregnant, don’t stop taking your epilepsy medicine. This could cause you to have more seizures or seizures that are more severe. This could be harmful for you and your baby. Speak to your GP urgently, so they can get you the help and advice you need.
Will I need to change my epilepsy medicine?
Sometimes, the benefits of taking medicine to control your seizures can outweigh any risk to a pregnancy. But your epilepsy specialist or ESN may suggest changing your epilepsy medicine to try and reduce the risk to your pregnancy as much as possible.
Your specialist will talk to you about how you’ve managed if you’ve changed medicines in the past, before agreeing next steps.
The National Institute for Health and Care Excellence (NICE) recommends that epilepsy specialists prescribe a lower dose of medicine during pregnancy. They should also prescribe only one type of epilepsy medicine if possible. This is called monotherapy. If this doesn’t work to control your seizures, they might suggest a higher dose. Or, give you more than one medicine.
Monitoring your epilepsy medicines during pregnancy
Your body goes through a lot of changes during pregnancy. So it might be necessary to monitor your epilepsy medicine and change the amount you take as your pregnancy progresses. We have more information about this on our pregnancy and epilepsy page.
Folic acid and epilepsy
All pregnant people are advised to take folic acid during pregnancy. This helps your baby’s brain, skull and spinal cord to develop properly. Ideally, you should take 5 milligrams of folic acid a day as soon as you start trying to get pregnant.
Find out more about epilepsy and planning a baby.
Support for you
Epilepsy Action is here to support you.
Our helpline can help to answer any questions you might have about the information on this page. You can message online or call our helpline on 0808 800 5050
What are the risks for different epilepsy medicines?
Here, we explain the risks and safety information for epilepsy medicines during pregnancy commonly prescribed in the UK. This is based on a report by the Medicines and Healthcare products Regulatory Agency (MHRA). It was published in January 2021 and is updated as new evidence becomes available.
The MHRA also published a safety leaflet about epilepsy medicines and pregnancy.
You can use this information to help you have an informed discussion with your epilepsy specialist or ESN.
When we quote specific numbers for risk, the numbers come from large studies of people who have taken epilepsy medicines. There isn’t the same quality of study for every epilepsy medicine. This is why we sometimes say that there isn’t enough evidence to know how likely a risk may be.
We have used the generic name and the most common brand name for each one. To see more brand names, visit our webpage epilepsy medicines available in the UK.
Try to remember that the risks from uncontrolled seizures might outweigh the risk from epilepsy medicines. Your healthcare team will work with you to find the safest treatment for you and your baby throughout your pregnancy.
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Carbamazepine (brand name Tegretol)
Taking carbamazepine during pregnancy slightly increases the risk of physical birth defects. They include permanently underdeveloped nails and slightly altered facial features. For example, wide spaced eyes or tiny skin folds at the inner corners of the eyes.
If 100 people take carbamazepine during their pregnancy, 4 to 5 babies will be born with physical birth defects.
This compares with 2 to 3 out of 100 babies that are born with physical birth defects in the general population.
The available information about carbamazepine’s effect on learning and thinking difficulties is limited. It does not suggest an increased risk if taken during pregnancy.
There have been some reported cases of carbamazepine leading to withdrawal symptoms in newborn babies. This means that there is a chance this could happen but there is not a lot of research in large numbers of people. Your baby may need to be monitored for a few days after they are born.
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Clobazam (brand name Frisium)
Research suggests clobazam may slightly increase the risk of a baby being born with birth defects. One study found that a small number of babies were born with a cleft lip or complications with how the heart develops. But there isn’t enough high quality evidence to prove the effects of clobazam during pregnancy. More evidence is needed from greater numbers of people.
There is a chance a baby will have withdrawal symptoms after they’re born if you take clobazam throughout pregnancy or during labour. Ask your specialist, epilepsy nurse or midwife if your baby will need monitoring after they are born.
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Cenobamate
Cenobamate was introduced to treat epilepsy in 2022. There isn’t enough evidence yet from humans about the effects this medicine has on unborn babies during pregnancy. But research in animals suggests that there may be a risk. The makers of cenobamate say it should not be used in pregnancy, unless the benefits outweigh the risks.
You are recommended to use contraception until 4 weeks after you stop taking this epilepsy medicine.
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Gabapentin (brand name Neurontin)
We don’t fully understand the risks of taking gabapentin during pregnancy yet. The MHRA was not able to make any firm conclusions about its safety in pregnancy. The risks of birth defects or issues with learning and thinking cannot be confirmed or ruled out.
The manufacturer advises that you should not take gabapentin in pregnancy unless the benefits outweigh the risks.
Babies may have withdrawal symptoms for a few days after they are born. Ask your specialist, epilepsy nurse or midwife if your baby will need monitoring after they are born.
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Lamotrigine (brand name Lamictal)
Lamotrigine is thought to be one of the safer epilepsy medicines to use during pregnancy. Research suggests that it does not increase the risk of birth defects. The risk is similar to the level of risk in the general population.
There is less information about the effects of lamotrigine on learning or thinking difficulties. The information available doesn’t suggest an increased risk compared to the general population. But information about this is quite limited. The possibility of an increased risk cannot be completely ruled out.
Research suggests using lamotrigine during pregnancy does not affect a baby’s growth in the womb.
Lamotrigine works in a similar way to other medicines that are known to cause withdrawal symptoms in newborn babies. Babies may have withdrawal symptoms after they are born. Ask your specialist, epilepsy nurse or midwife if your baby will need monitoring after they are born.
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Levetiracetam (brand name Keppra)
Levetiracetam is thought to be one of the safer epilepsy medicines to use during pregnancy. Research suggests that it does not increase the risk of birth defects compared with the general population.
There is less information about the effects of levetiracetam on learning or thinking difficulties. The data available does not suggest an increased risk compared to the general population. The possibility of an increased risk can not be completely ruled out.
Information suggests that using levetiracetam during pregnancy does not affect a baby’s growth in the womb.
Levetiracetam works in a similar way to other medicines that are known to cause withdrawal symptoms in newborn babies. Babies may have withdrawal symptoms after they are born. Ask your specialist, epilepsy nurse or midwife if your baby will need monitoring after they are born.
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Oxcarbazepine (brand name Trileptal)
There is not enough research to know if taking oxcarbazepine can be harmful during pregnancy.
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Phenobarbital
Taking phenobarbital during pregnancy increases the risk of physical birth defects.
If 100 people take phenobarbital during their pregnancy, 6 to 7 of the babies will be born with birth defects. This compares with 2 to 3 out of 100 babies that are born with birth defects in the general population.
One example of these birth defects is heart complications.
Evidence suggests that the risk of birth defects is higher if you take a higher dose of phenobarbital.
Taking this medicine during pregnancy increases the risk of the baby being born smaller than expected. This is compared to the general population.
Phenobarbital may also increase the risk of a child having difficulties with learning and thinking. Although the exact risk is not known, it is not as high as for valproate. Valproate causes difficulties in 30 to 40 out of 100 children.
Babies may have withdrawal symptoms after they are born. Ask your specialist, epilepsy nurse or midwife if your baby will need monitoring after they are born
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Phenytoin (brand name Epanutin)
Taking phenytoin during pregnancy increases the risk of birth defects. If 100 people take phenytoin during their pregnancy, 6 of the babies will be born with birth defects. This compares with 2 to 3 out of 100 babies that are born with birth defects in the general population.
It can also increase the risk of a child having difficulties with learning and thinking. The exact risk is not known, but it is not as high as for valproate. Valproate medicines cause learning and thinking problems in 30 to 40 out of 100 children.
The evidence that exists at the moment does not show that phenytoin affects the growth of a baby in the womb.
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Pregabalin (brand name Lyrica)
Pregabalin can increase the risk of birth defects if taken during the first 3 months of pregnancy. Research suggests that if 100 people take pregabalin during their pregnancy, 6 babies will be born with birth defects. This compares with 2 to 3 out of 100 babies that are born with birth defects in the general population.
The MHRA have made a leaflet explaining the risks about pregabalin in pregnancy.
The NICE guidelines recommend that you do not take pregabalin during pregnancy unless the benefits outweigh the risks. For example, it might be safer overall to effectively control your seizures.
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Primidone
Primidone was not included in the MHRA review. But it may increase the risk of birth defects if taken during pregnancy. The exact risk is not clear from the information available.
Taking primidone in the last 3 months of pregnancy can cause withdrawal symptoms in newborn babies. Ask your specialist, epilepsy nurse or midwife if your baby will need monitoring after they are born.
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Topiramate (brand name Topamax)
The MHRA introduced rules in June 2024 about taking topiramate. This is after an evidence review of the risks of taking topiramate in pregnancy for an unborn baby.
The rules have been introduced to make sure more people understand the risks of taking topiramate in pregnancy.
You can find out more on our page about topiramate and risks in pregnancy.
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Valproate (sodium valproate, brand name Epilim)
Medicines containing valproate have a high risk of harming an unborn baby if taken during pregnancy. This includes sodium valproate and valproic acid.
You can find more information about the risks and rules for taking valproate medicines on our sodium valproate medicine page.
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Zonisamide (brand name Zonegran)
More research is needed to understand if taking zonisamide during pregnancy increases the risk of birth defects. The risk cannot be confirmed or ruled out based on current research.
The same is true for the risk of a child having thinking or learning difficulties.
Zonisamide use during pregnancy increases the risk of the baby being born smaller than expected. This is compared with the general population.
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Other epilepsy medicines
There was not enough evidence for the MRHA to make conclusions about the safety of some medicines in pregnancy. The possibility of risks cannot be confirmed or ruled out. These medicines include:
- Brivaracetam (Briviact)
- Clonazepam
- Eslicarbazepine (Zebinix)
- Ethosuximide
- Lacosamide (Vimpat)
- Perampanel (Fycompa)
- Rufinamide (Inovelon)
- Tiagabine (Gabitril)
- Vigabatrin (Sabril)
Not every medicine was reviewed by the MHRA. If your medicine is not on this list, you can:
Which epilepsy medicines are safest to use in pregnancy?
Lamotrigine and levetiracetam are thought to be safer to use in pregnancy than other epilepsy medicines. This is based on the results of the MHRA investigation. They are not linked with an increased risk of birth defects, compared with the general population.
I think my child has been affected by epilepsy medicine I took while I was pregnant. What should I do?
Speak to your doctor if you are concerned that your child has been affected by use of epilepsy medicine during pregnancy. They may refer your child to see a specialist in children’s medicine.
You could also contact a support network such as:
Organisation for Anti-convulsant Syndrome (OACS)
OACS support all families touched by Fetal Anti-Convulsant Syndromes
Valproate Victims
This charity represents some of the people and families who have been affected by sodium valproate taken in pregnancy.
INFACT
INFACT helps anyone that has taken epilepsy medicines in pregnancy. They offer information, advice and support. They can help if you’re concerned it may have affected your baby during pregnancy.
UK Epilepsy and Pregnancy Register
The UK Epilepsy and Pregnancy Register was set up to find out more about having epilepsy during pregnancy. This includes taking epilepsy medicines during pregnancy.
If you have epilepsy and are pregnant, you can visit their website or call on 0800 389 1248.
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