When you're taking medication to control seizures, planning a pregnancy isn't just about getting pregnant-it’s about making sure both you and your baby stay safe. Many people don’t realize that some of the most effective seizure medications can increase the risk of birth defects or interfere with birth control. The truth is, seizure medications aren’t one-size-fits-all when it comes to pregnancy. Some are far safer than others, and knowing the difference can change everything.
Which Seizure Medications Carry the Highest Risks?
Not all antiseizure drugs are created equal when it comes to pregnancy. The biggest red flag is sodium valproate (valproic acid). Studies show that about 10% of babies exposed to this drug in the womb develop major physical birth defects-things like heart problems, cleft lip or palate, spinal cord issues, and microcephaly (a smaller-than-normal head size). The risk goes up with higher doses. That’s more than double the rate seen with other medications.
Other high-risk drugs include carbamazepine (Tegretol), phenytoin (Epanutin), phenobarbital, and topiramate (Topamax). These are linked to increased chances of heart defects, facial abnormalities, and slow fetal growth. The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) has flagged these four specifically for their known teratogenic effects.
But here’s the important part: even with these risks, over 90% of babies born to women with epilepsy are healthy. That’s not luck-it’s because more doctors are now avoiding high-risk drugs and switching patients to safer options before pregnancy even begins.
The Safer Alternatives: Lamotrigine and Levetiracetam
If you’re planning a pregnancy, the best news is that two medications stand out as much safer: lamotrigine (Lamictal) and levetiracetam (Keppra). Research from the MHRA and multiple studies, including one from Stanford published in JAMA Neurology, show that babies exposed to these drugs in utero have similar development outcomes to babies whose mothers didn’t take any seizure medication at all.
One study tracked 298 children exposed to newer-generation ASMs and found no difference in verbal skills at age two. That’s huge. It means you can manage your seizures effectively without putting your baby at high risk.
These two drugs are now the first-line recommendation for women of childbearing age who need seizure control. They work well for many types of epilepsy, and when used at the right dose, they keep seizures under control without the same level of fetal risk.
How Drug Interactions Can Put You at Risk
Here’s something many people miss: seizure medications don’t just affect your baby-they can mess with your birth control. And vice versa.
Drugs like carbamazepine, phenytoin, phenobarbital, and high-dose topiramate can make hormonal birth control-pills, patches, rings-less effective. That means even if you’re taking your pill every day, you could still get pregnant without realizing it.
On the flip side, hormonal contraceptives can lower the levels of certain seizure medications in your blood. That’s especially true for lamotrigine, valproate, zonisamide, and rufinamide. If your lamotrigine level drops too low, you could start having seizures again.
This creates a dangerous loop: you take birth control to avoid pregnancy, but the medication makes the birth control fail-and if you do get pregnant, you might still be on a high-risk drug because your seizure control slipped. That’s why talking to your neurologist and gynecologist together is non-negotiable.
Why Uncontrolled Seizures Are Even More Dangerous
It’s easy to focus only on the risks of the drugs. But here’s the reality: having a tonic-clonic seizure during pregnancy is extremely dangerous. It can cause oxygen loss to the baby, trigger premature labor, lead to miscarriage, or result in serious injury to both you and your child.
Experts agree: no seizure medication is as dangerous as uncontrolled seizures. That’s why stopping your meds on your own is never the answer. The goal isn’t to avoid all medication-it’s to use the safest possible option at the lowest effective dose.
A 2020 study from Indiana University called this an “excruciating double bind.” You need the drug to survive, but the drug might harm your baby. That’s why planning ahead is everything.
Preconception Counseling Is Not Optional
If you’re a woman of childbearing age and you take seizure medication, you should have had a conversation with your doctor about pregnancy-even if you’re not planning to get pregnant right now. Why? Because half of all pregnancies are unplanned. And if you’re on valproate and get pregnant without knowing, the damage can start in the first few weeks-before you even miss a period.
Preconception counseling means reviewing your current meds, switching to safer alternatives if needed, adjusting your dose, and making sure your birth control is working properly. It also includes checking your blood levels of lamotrigine or other drugs if you’re using hormonal contraception.
Studies show that only about one-third of women with epilepsy get care that matches their reproductive goals. That’s not good enough. You deserve to plan your pregnancy safely.
The Big Picture: Things Are Getting Better
The good news? Things are improving. Between 1997 and 2011, the rate of major birth defects linked to seizure medications dropped by 39%. Why? Because doctors stopped prescribing valproate to women of childbearing age unless absolutely necessary. They started using lamotrigine and levetiracetam more often. They started testing drug levels before and during pregnancy.
But progress isn’t even. A French study found that women with lower income or less access to healthcare were more likely to still be on high-risk drugs during pregnancy. That’s a systemic issue-lack of access to specialists, long wait times, or not being offered safer alternatives.
And while we know a lot about the top six or seven drugs, there are still 11 others where we don’t have enough data to say they’re safe. That’s why ongoing research and reporting side effects matter.
What You Should Do Right Now
- If you’re on valproate and thinking about pregnancy-talk to your neurologist immediately. Don’t wait.
- If you’re on carbamazepine, phenytoin, phenobarbital, or topiramate, ask if you can switch to lamotrigine or levetiracetam.
- If you’re using hormonal birth control, ask your doctor if your seizure meds are making it less effective. You might need a higher-dose pill, an IUD, or another method.
- If you’re not on birth control and not planning pregnancy, make sure you’re using a reliable method. Don’t assume you’re safe.
- Keep your seizure diary. Track how often you have seizures and any side effects. That data helps your doctor adjust your treatment.
- Find a specialist who understands epilepsy and pregnancy. Not all neurologists do.
Having epilepsy doesn’t mean you can’t have a healthy baby. But it does mean you need to be proactive. The safest path isn’t about avoiding medication-it’s about choosing the right one, at the right dose, at the right time.
Can I stop my seizure medication if I get pregnant?
No. Stopping seizure medication without medical supervision can lead to uncontrolled seizures, which are far more dangerous to both you and your baby than the medications themselves. Always talk to your doctor before making any changes.
Is lamotrigine safe during pregnancy?
Yes. Lamotrigine is one of the safest antiseizure medications for pregnancy. Studies show no significant increase in birth defects or developmental delays in children exposed to it before birth. However, its levels drop during pregnancy, so your doctor may need to adjust your dose.
Do seizure medications affect fertility?
There’s no strong evidence that seizure medications reduce fertility. However, some drugs like valproate can affect hormone levels, which might impact ovulation. If you’re having trouble conceiving, talk to your doctor about your medication and possible alternatives.
Can I breastfeed while taking seizure medication?
Yes, most antiseizure medications are considered safe during breastfeeding. Lamotrigine and levetiracetam pass into breast milk in very small amounts and are generally well-tolerated by babies. Valproate is less ideal but can still be used with monitoring. Always check with your doctor.
How often should I get my blood levels checked during pregnancy?
If you’re taking lamotrigine, levetiracetam, or other drugs affected by pregnancy, your doctor will likely check your blood levels every 4 to 8 weeks. Hormonal changes during pregnancy can lower drug levels, increasing seizure risk. Regular monitoring helps keep you protected.
Are newer seizure medications safer than older ones?
Generally, yes. Medications developed after the 1990s-like lamotrigine, levetiracetam, and lacosamide-have better safety profiles during pregnancy than older drugs like valproate, phenytoin, and phenobarbital. But safety varies by individual, so your doctor will choose based on your seizure type and medical history.
