Seizure Medications and Pregnancy: Risks of Birth Defects and Drug Interactions
Dec, 1 2025
When youâre taking medication to control seizures, planning a pregnancy isnât just about timing-itâs about survival. For women with epilepsy, the choice isnât between taking medicine or not. Itâs 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 youâre using birth control? Thatâs 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. Thatâs 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 hereâs the important part: even with these drugs, most babies-over 90%-are born healthy. The risk is real, but itâs not guaranteed.
The safer options? Lamotrigine (Lamictal) and levetiracetam (Keppra). Multiple studies, including one from the UKâs 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. Thatâs a huge shift from the past.
Why Did We Wait So Long to Know This?
It wasnât 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%. Thatâs not luck. Itâs because doctors started choosing safer drugs, using lower doses, and offering better preconception care. But the progress isnât equal. A French study found that women with fewer financial resources were more likely to be prescribed high-risk drugs during pregnancy. Thatâs not just a medical issue-itâs a justice issue.
Birth Control and Seizure Meds Donât Play Nice
If youâre on hormonal birth control-pills, patches, rings-and you take certain seizure meds, your birth control might not work. Thatâs not a myth. Itâs 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 youâre 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. Thatâs especially true for lamotrigine, valproate, zonisamide, and rufinamide. If your seizure control slips, youâre at risk for a seizure during pregnancy-which is even more dangerous than the medication itself.
This isnât just about missing a pill. Itâs 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. Thatâs not their fault. Itâs a gap in care.
Uncontrolled Seizures Are the Real Danger
Hereâs what no one wants to say out loud: stopping your seizure meds because youâre 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. Thatâs not theoretical. It happens. And the risk is higher than the risk from most medications.
Thatâs why experts call it an âexcruciating double bind.â You need the drug to survive. But the drug might hurt your baby. The answer isnât to stop. Itâs to switch. To adjust. To plan.
The American Epilepsy Society says it clearly: no seizure medication is as dangerous as uncontrolled seizures. Thatâs why preconception counseling isnât optional. Itâs essential. If youâre thinking about getting pregnant, see your neurologist and your OB-GYN-at least three to six months before you try. Thatâs enough time to switch to a safer drug, fine-tune your dose, and make sure your birth control isnât conflicting with your meds.
What Should You Do Right Now?
If youâre taking a seizure medication and youâre sexually active:
- Donât stop your meds. Not without talking to your doctor. Seizures are dangerous.
- Ask what drug youâre on. Is it valproate? Phenytoin? Topiramate? If yes, talk to your doctor about alternatives like lamotrigine or levetiracetam.
- Check your birth control. If youâre 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 youâre 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 youâre already pregnant? Donât panic. Donât 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.
Whatâs Still Unknown?
There are 11 other seizure medications that still lack enough data to say if theyâre safe during pregnancy. That means weâre 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 doesnât mean you canât 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 Iâm 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 babyâs doctor may monitor for drowsiness or feeding issues. Always check with your provider before starting breastfeeding, but donât assume you need to stop.
Why do some women still get prescribed high-risk seizure meds during pregnancy?
Some women donât have access to specialists who know about safer alternatives. Others are in areas where older, cheaper drugs are still used because theyâre more available. A 2023 study found women with lower socioeconomic resources were more likely to be on high-risk meds. Itâs not always about choice-itâs 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.
Whatâs Next?
If youâre 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 doesnât know the latest guidelines, ask for a referral to an epilepsy specialist who works with pregnant patients. You deserve care thatâs 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. Whatâs left is for you to use them. Your health matters. Your future children matter. And you donât have to choose between them.
Jack Arscott
December 1, 2025 AT 23:41Thank you for this. đ Iâve been on lamotrigine for 8 years and just found out Iâm pregnant. I cried reading this. I didnât know I was one of the lucky ones. đ
Declan Flynn Fitness
December 2, 2025 AT 22:35Same. I switched from valproate to levetiracetam before trying. My OB didnât even know the risks. Took me 3 months of research to find a neurologist who actually cared. Youâre not alone. đŞ
Irving Steinberg
December 3, 2025 AT 16:31Wow another doomsday article. People are gonna panic and quit their meds. Thatâs worse than the meds. Just chill. Most babies are fine. đ¤ˇââď¸
Lydia Zhang
December 4, 2025 AT 19:30Interesting. I didnât know birth control and seizure meds interacted. My doctor never mentioned it.
Adrian Barnes
December 6, 2025 AT 08:13It is both tragic and predictable that systemic negligence has led to generations of preventable birth defects. The medical-industrial complex prioritizes profit over pediatric safety. Valproate remains on formularies not because it is effective, but because it is cheap and patent-expired. This is not a clinical issue-it is an ethical catastrophe.
Matt Dean
December 7, 2025 AT 02:09Wait so if you're on topiramate and on the pill, you could get pregnant even if you take it perfectly? That's wild. My sister just had a baby and she was on topiramate. She had no clue. This is insane. Who's teaching doctors this stuff?
Michelle Smyth
December 7, 2025 AT 02:17Itâs fascinating how the epistemological framework of pharmacovigilance has been historically gendered. The exclusion of reproductive populations from clinical trials isnât an oversight-itâs a structural epistemic violence. Lamotrigineâs safety profile is only now being validated because weâve finally begun to interrogate the patriarchal foundations of neuropharmacology.
Souvik Datta
December 8, 2025 AT 14:06Youâre not broken. Youâre not a risk. Youâre a person who deserves better care-and youâre not alone. Iâve seen women with epilepsy raise amazing kids on lamotrigine. Itâs not easy, but itâs possible. Talk to your doctor. Get a second opinion. Plan. Youâve got this.
Walker Alvey
December 9, 2025 AT 09:39Oh so now weâre supposed to feel guilty for taking meds that keep us alive? Maybe the real problem is that society expects women to be perfect mothers while ignoring that theyâre also sick people. Letâs just blame the woman again. Classic.
Patrick Smyth
December 9, 2025 AT 21:01This is the most terrifying thing Iâve ever read. My wife is on valproate. She had a seizure last week. We didnât even know about the risks. I feel like Iâve been living in a nightmare. Weâre seeing a specialist tomorrow. I just hope itâs not too late.
Priyam Tomar
December 11, 2025 AT 00:30Lamotrigine is safe? Thatâs what they say now. Last year it was âmaybeâ. Next year itâll be âweâre not sureâ. This is how science works. People panic over one study and then flip-flop. You think your babyâs safe? Wait 10 years. ADHD rates will spike. It always does.
Linda Migdal
December 11, 2025 AT 03:08Why are we letting foreign drug guidelines dictate American care? We have better science here. Lamotrigine might be fine for Europeans but our population has different metabolic profiles. We need US-specific data, not EU studies.
Kay Lam
December 12, 2025 AT 13:23I want to say thank you to the women whoâve shared their stories and to the doctors who are finally listening. This isnât just about pills and seizures. Itâs about being seen. Itâs about being trusted to make decisions about your own body. For decades, women with epilepsy were told not to have kids. Now weâre being told how to have them safely. Thatâs progress. Itâs slow. Itâs messy. But itâs real. And if youâre reading this and youâre scared-youâre not alone. Find your team. Ask the hard questions. Push for the right meds. Your life matters. Your future child matters. You are not a statistic. You are a person who deserves a chance.