Anti-Seizure Medications for Pregnancy

Medications to Avoid or Use with Extreme Caution

• The American Academy of Neurology recommends that valproate be avoided in pregnant women and women of childbearing potential whenever possible, due to its high risk of neural tube defects and negative impacts on neuropsychological development in children exposed in utero 1
• If valproate is absolutely necessary, the patient must be fully informed of risks and folic acid supplementation is mandatory, as recommended by the American Academy of Neurology 1

Breastfeeding Recommendations

• The American Academy of Pediatrics recommends that women on anti-seizure medication monotherapy be encouraged to breastfeed, as most medications are moderately safe, with standard breastfeeding recommendations applying for phenobarbital, phenytoin, carbamazepine, and valproic acid 1

Essential Supplementation

• The American College of Obstetricians and Gynecologists recommends that folic acid supplementation is mandatory for all women with epilepsy who are pregnant or planning pregnancy, with a daily dose of 4 mg starting at least one month before conception and continuing through the first trimester 1, 2