Seizure Medications and Pregnancy: Risks of Birth Defects and Drug Interactions
Dec, 1 2025
When you’re taking medication to control seizures, planning a pregnancy isn’t just about timing-it’s about survival. For women with epilepsy, the choice isn’t between taking medicine or not. It’s between one set of risks and another. Take too little, and a seizure could harm you or your baby. Take the wrong one, and you might put your child at risk for serious birth defects. And if you’re using birth control? That’s another layer of danger you might not even know about.
Some Seizure Medications Are Much Riskier Than Others
Not all seizure medications are created equal when it comes to pregnancy. The biggest red flag? Valproate-also known as sodium valproate or valproic acid. This drug has been linked to more than double the risk of autism and nearly twice the risk of ADHD in children exposed before birth. Around 10% of babies exposed to valproate during pregnancy develop major physical birth defects, including heart problems, cleft lips or palates, and spina bifida. The risk goes up with higher doses. That’s why experts now say: if you can avoid it, do.
Other high-risk drugs include carbamazepine (Tegretol), phenytoin (Epanutin), phenobarbital, and topiramate (Topamax). These are tied to increased chances of heart defects, slow fetal growth, and microcephaly (a smaller-than-normal head size). But here’s the important part: even with these drugs, most babies-over 90%-are born healthy. The risk is real, but it’s not guaranteed.
The safer options? Lamotrigine (Lamictal) and levetiracetam (Keppra). Multiple studies, including one from the UK’s Medicines and Healthcare products Regulatory Agency, show these two carry the lowest risk of birth defects. In fact, a Stanford study tracking 298 children found no difference in language development at age two between babies exposed to these newer drugs and those not exposed at all. That’s a huge shift from the past.
Why Did We Wait So Long to Know This?
It wasn’t always this way. Before the 1960s, women with epilepsy were often told not to marry, let alone have children. Some U.S. states even banned marriage for people with epilepsy. The stigma was real, and the medical advice was worse. When better seizure drugs came along, they were hailed as miracles-without testing them on pregnant women. Valproate, for example, became a go-to because it worked well. No one knew how dangerous it was until thousands of children were born with problems.
It took decades of research to untangle the risks. A 2024 study showed that between 1997 and 2011, the rate of major birth defects linked to seizure meds dropped by 39%. That’s not luck. It’s because doctors started choosing safer drugs, using lower doses, and offering better preconception care. But the progress isn’t equal. A French study found that women with fewer financial resources were more likely to be prescribed high-risk drugs during pregnancy. That’s not just a medical issue-it’s a justice issue.
Birth Control and Seizure Meds Don’t Play Nice
If you’re on hormonal birth control-pills, patches, rings-and you take certain seizure meds, your birth control might not work. That’s not a myth. It’s science. Drugs like carbamazepine, phenytoin, phenobarbital, and high-dose topiramate speed up how your body breaks down hormones. That means less protection. You could get pregnant even if you’re taking your pill every day.
And it works the other way, too. Hormonal birth control can lower the levels of some seizure meds in your blood. That’s especially true for lamotrigine, valproate, zonisamide, and rufinamide. If your seizure control slips, you’re at risk for a seizure during pregnancy-which is even more dangerous than the medication itself.
This isn’t just about missing a pill. It’s about systems failing. A 2023 study found that nearly two-thirds of women of childbearing age with epilepsy answered basic questions about these interactions incorrectly. Many never even talked to their doctor about it. That’s not their fault. It’s a gap in care.
Uncontrolled Seizures Are the Real Danger
Here’s what no one wants to say out loud: stopping your seizure meds because you’re scared of birth defects could kill you-or your baby. A tonic-clonic seizure during pregnancy can cause miscarriage, premature labor, or oxygen deprivation to the fetus. That’s not theoretical. It happens. And the risk is higher than the risk from most medications.
That’s why experts call it an “excruciating double bind.” You need the drug to survive. But the drug might hurt your baby. The answer isn’t to stop. It’s to switch. To adjust. To plan.
The American Epilepsy Society says it clearly: no seizure medication is as dangerous as uncontrolled seizures. That’s why preconception counseling isn’t optional. It’s essential. If you’re thinking about getting pregnant, see your neurologist and your OB-GYN-at least three to six months before you try. That’s enough time to switch to a safer drug, fine-tune your dose, and make sure your birth control isn’t conflicting with your meds.
What Should You Do Right Now?
If you’re taking a seizure medication and you’re sexually active:
- Don’t stop your meds. Not without talking to your doctor. Seizures are dangerous.
- Ask what drug you’re on. Is it valproate? Phenytoin? Topiramate? If yes, talk to your doctor about alternatives like lamotrigine or levetiracetam.
- Check your birth control. If you’re on the pill, patch, or ring, ask if your seizure meds make it less effective. You might need a higher-dose pill, an IUD, or a non-hormonal option.
- Plan ahead. If you’re thinking about pregnancy, start this conversation now-not when you miss a period.
- Track your dose. Higher doses of carbamazepine, phenobarbital, and valproate increase birth defect risk. Your goal is the lowest effective dose.
And if you’re already pregnant? Don’t panic. Don’t quit. Call your doctor. Many women have had healthy babies while on seizure meds. The key is knowing which ones are safest and staying in control.
What’s Still Unknown?
There are 11 other seizure medications that still lack enough data to say if they’re safe during pregnancy. That means we’re still learning. Researchers are tracking outcomes for babies exposed to newer drugs like cenobamate, eslicarbazepine, and perampanel. But right now, the safest path is clear: use lamotrigine or levetiracetam if you can. Avoid valproate. Always talk to your care team.
The good news? The future is better than the past. More women are being offered safer options. More doctors are asking about pregnancy plans. More women are surviving their seizures-and having healthy babies. But it still takes action. You have to speak up. You have to ask. You have to demand better care.
Having epilepsy doesn’t mean you can’t be a parent. It means you need a smarter plan. And that plan starts with knowing the risks-and who to talk to about them.
Are all seizure medications dangerous during pregnancy?
No. While some seizure medications like valproate, phenytoin, and topiramate carry higher risks of birth defects, others like lamotrigine and levetiracetam are considered much safer. Studies show children exposed to these two drugs during pregnancy have normal development rates, especially for language and motor skills. The key is choosing the right medication before conception.
Can birth control pills work with seizure meds?
It depends. Carbamazepine, phenytoin, phenobarbital, and high-dose topiramate can reduce the effectiveness of hormonal birth control like pills, patches, or rings. Conversely, hormonal birth control can lower levels of lamotrigine, valproate, and other seizure meds, making seizures more likely. You need to talk to your doctor about your specific combo. An IUD or non-hormonal method may be safer.
What should I do if I’m already pregnant and taking valproate?
Do not stop taking it on your own. Stopping suddenly can trigger dangerous seizures. Contact your neurologist and OB-GYN immediately. They may gradually switch you to a safer medication like lamotrigine or levetiracetam, depending on your seizure control. Your care team will monitor you and your baby closely throughout the pregnancy.
Is it safe to breastfeed while taking seizure meds?
Yes, for most medications. Lamotrigine and levetiracetam pass into breast milk in very small amounts and are considered safe. Even valproate is usually okay in low doses, though your baby’s doctor may monitor for drowsiness or feeding issues. Always check with your provider before starting breastfeeding, but don’t assume you need to stop.
Why do some women still get prescribed high-risk seizure meds during pregnancy?
Some women don’t have access to specialists who know about safer alternatives. Others are in areas where older, cheaper drugs are still used because they’re more available. A 2023 study found women with lower socioeconomic resources were more likely to be on high-risk meds. It’s not always about choice-it’s about access. Advocating for yourself and seeking a neurologist experienced in epilepsy and pregnancy can change the outcome.
Can I get pregnant if I have epilepsy?
Absolutely. Most women with epilepsy have healthy pregnancies and healthy babies. The key is planning. Talk to your doctor at least six months before trying to conceive. Switch to safer meds if needed. Adjust your birth control. Get your dose right. With the right care, your chances of a safe pregnancy are very high.
What’s Next?
If you’re on seizure medication and thinking about pregnancy-or just want to make sure your current plan is safe-your next step is simple: schedule a conversation with your neurologist. Bring a list of your meds, your birth control method, and your questions. If your doctor doesn’t know the latest guidelines, ask for a referral to an epilepsy specialist who works with pregnant patients. You deserve care that’s informed, current, and tailored to your life.
The old days of silence and fear are over. We know more now. We have safer tools. We have better data. What’s left is for you to use them. Your health matters. Your future children matter. And you don’t have to choose between them.