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Reviewed by the Faculty of Harvard Medical School

Epilepsy and Pregnancy

If you're among the 800,000 American women of childbearing age with epilepsy, you and your obstetrician will have some medical decisions to make. The crux of the dilemma is that anti-epileptic medications used to prevent seizures create a medically significant risk to your child and not taking these drugs could result in your having convulsions that could also damage an unborn infant. Before stopping or starting medications for epilepsy, you should talk with your doctor. Here's a chart listing several common anti-epileptic medications and the hazard they might pose during pregnancy:

Brand Name

Generic Name

Possible Fetal Risks

Dilantin
Phenytoin
Doubles or triples the chance of birth defects; also 11 percent risk of face, skull or limb deformities; some cases of fatal hemorrhage in newborns; may be linked to unusual childhood cancers
Mesantoin
Mephenytoin
Same as for Dilantin
Phenobarbital
Same
Slightly higher risk of cleft palate or lip and congenital heart disease; can cause fetal addiction and newborn withdrawal symptoms; or newborn hemorrhage
Mysoline
Primidone
Not fully known, but thought to be similar to phenobarbital
Tridione
Trimethadione
Can cause fetal death; should never be used during pregnancy
Tegretol
Carbamazepine
Classified as less risky than any of the preceding drugs, but is linked to minor defects and an elevated risk of spina bifida
Depakene
Valproic acid
Can cause major birth defects, jaundice or fatal liver problems, clotting disorders, or impaired fetal growth. Most experts feel it shouldn't be used in pregnancy
Zarontin
Ethosuximide
Some cases of abnormalities, but believed safer than other petit mal medications
Klonopin
Clonazepam
Can cause lethargy, respiratory arrest, lack of muscle tone, low levels of blood oxygen if used near the end of pregnancy

Before you decide to conceive, consult your neurologist about your medications. It's possible you may not need to take anti-epileptic medications during pregnancy if you've been seizure-free for several years and have normal brain waves. In general, women with epilepsy have twice the risk of giving birth to a baby with congenital anomalies as a woman who doesn't have epilepsy, but anti-epileptic medications account for only part of this increased risk.

If you do need medication, you may be able to reduce the risk of birth defects significantly by changing from a combination of two or more drugs to a single anticonvulsant, or by taking lower, more frequent doses of your medication. Ask your doctor about these possibilities.

You should also remember that if you need to use Dilantin or Mesantoin (a class of medications called hydantoins) your chances of having a healthy, normal baby are almost 90 percent, while the prospect of a positive pregnancy outcome is even higher if you use phenobarbital.

If you choose pregnancy, the doctor should do a maternal serum alpha-fetoprotein test between weeks 15 and 18 to check for neural tube defects (which include spina bifida), especially if you used valproic acid during your first three months of pregnancy. To safeguard against this problem, you should start supplements of folic acid before you conceive and continue to take them during pregnancy.

You can help researchers gain more insight into epilepsy and pregnancy by enrolling in the Antiepileptic Drug Pregnancy Registry.

Last updated August 4, 2006




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