Epilepsy: Pregnancy and Breast Feeding

Key points

• Epilepsy: pregnancy and breast feeding The risks of uncontrolled epilepsy during pregnancy generally outweigh the risks of medication to the fetus.
• aim for monotherapy
• there is no indication to monitor antiepileptic drug levels
• sodium valproate: associated with neural tube defects
• MHRA safety review (January 2021): LAMOTRIGINE and LEVETIRACETAM are the safer antiseizure medicines in pregnancy — at usual maintenance doses they do not increase the risk of major congenital malformations above the background rate. CARBAMAZEPINE, phenobarbital, phenytoin and topiramate ARE associated with an increased risk of major congenital malformations, so carbamazepine should NOT be described as the least teratogenic option.
• All women and girls on antiseizure medication who could become pregnant should be offered FOLIC ACID 5 mg DAILY before any possibility of pregnancy · prescribe monotherapy at the lowest effective dose wherever possible, and refer urgently for specialist advice when pregnancy is planned.