Editing Anticonvulsant (section)

== Pregnancy ==
{{See also|Epilepsy and pregnancy}}

Many of the commonly used '''anticonvulsant/anti-seizure''' medications (ASMs), such as valproate, phenytoin, carbamazepine, phenobarbitol, gabapentin have been reported to cause an increased risk of [[birth defect]]s including major congenital malformations such as neural tube defects.<ref name=":0">{{cite journal |last1=Bromley |first1=Rebecca |last2=Adab |first2=Naghme |last3=Bluett-Duncan |first3=Matt |last4=Clayton-Smith |first4=Jill |last5=Christensen |first5=Jakob |last6=Edwards |first6=Katherine |last7=Greenhalgh |first7=Janette |last8=Hill |first8=Ruaraidh A. |last9=Jackson |first9=Cerian F. |last10=Khanom |first10=Sonia |last11=McGinty |first11=Ronan N. |last12=Tudur Smith |first12=Catrin |last13=Pulman |first13=Jennifer |last14=Marson |first14=Anthony G. |date=2023-08-29 |title=Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child |journal=The Cochrane Database of Systematic Reviews |volume=2023 |issue=8 |pages=CD010224 |doi=10.1002/14651858.CD010224.pub3 |issn=1469-493X |pmc=10463554 |pmid=37647086}}</ref> The risk of birth defects associated with taking these medications while pregnant may be dependent on the dose of the drug and on the timing of gestation (how well developed the baby is).<ref name=":0" /> While trying to conceive a child and during pregnancy, medical advice should be followed to optimize the management of the person's epilepsy in order to keep the person and the unborn baby safe from epileptic seizures and also ensure that the risk of birth defects due to ''in utero'' exposure of anticonvulsants is as low as possible.<ref name="Harden" /> Anticonvulsant medications should be carefully monitored during use in pregnancy.<ref name="Harden">{{cite journal |display-authors=etal |vauthors=Harden CL, Pennell PB, Koppel BS |date=May 2009 |title=Management issues for women with epilepsy—focus on pregnancy (an evidence-based review): III. Vitamin K, folic acid, blood levels, and breast-feeding: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society |journal=Epilepsia |volume=50 |issue=5 |pages=1247–55 |doi=10.1111/j.1528-1167.2009.02130.x |pmid=19507305 |s2cid=221731995 |doi-access=free}}</ref><ref>{{cite journal |last=George |first=Ilena C. |date=2017 |title=Practice Current: How do you treat epilepsy in pregnancy? |journal=Neurology: Clinical Practice |volume=7 |issue=4 |pages=363–371 |doi=10.1212/cpj.0000000000000387 |issn=2163-0402 |pmc=5648199 |pmid=29185530}}</ref> For example, since the first trimester is the most susceptible period for fetal development, planning a routine antiepileptic drug dose that is safer for the first trimester could be beneficial to prevent pregnancy complications.

[[Valproic acid]], and its derivatives such as [[sodium valproate]] and [[divalproex sodium]], causes [[cognitive deficit]] in the child, with an increased dose causing decreased [[intelligence quotient]] and use is associated with adverse neurodevelopmental outcomes (cognitive and behavioral)  in children.<ref name="BromleyWeston2014">{{cite journal|last1=Bromley|first1=Rebecca|last2=Weston|first2=Jennifer|last3=Adab|first3=Naghme|last4=Greenhalgh|first4=Janette|last5=Sanniti|first5=Anna|last6=McKay|first6=Andrew J|last7=Tudur Smith|first7=Catrin|last8=Marson|first8=Anthony G|title=Treatment for epilepsy in pregnancy: neurodevelopmental outcomes in the child|year=2014|doi=10.1002/14651858.CD010236.pub2|pmid=25354543|journal=Reviews|volume=2020|issue=10|pages=CD010236|pmc=7390020}}</ref><ref>{{cite journal |last1=Tomson |first1=Torbjörn |last2=Marson |first2=Anthony |last3=Boon |first3=Paul |last4=Canevini |first4=Maria Paola |last5=Covanis |first5=Athanasios |last6=Gaily |first6=Eija |last7=Kälviäinen |first7=Reetta |last8=Trinka |first8=Eugen |date=July 2015 |title=Valproate in the treatment of epilepsy in girls and women of childbearing potential |journal=Epilepsia |language=en |volume=56 |issue=7 |pages=1006–1019 |doi=10.1111/epi.13021 |issn=0013-9580 |doi-access=free |pmid=25851171 |url=https://biblio.ugent.be/publication/6985189/file/7011646 |access-date=1 March 2024 |archive-date=1 March 2024 |archive-url=https://web.archive.org/web/20240301162525/https://biblio.ugent.be/publication/6985189/file/7011646 |url-status=live }}</ref> On the other hand, evidence is conflicting for [[carbamazepine]] regarding any increased risk of [[congenital physical anomalies]] or [[neurodevelopmental disorder]]s by intrauterine exposure.<ref name="BromleyWeston2014" /> Similarly, children exposed [[lamotrigine]] or [[phenytoin]] in the womb do not seem to differ in their skills compared to those who were exposed to carbamazepine.<ref name="BromleyWeston2014" /> 

There is inadequate evidence to determine if newborns of women with epilepsy taking anticonvulsants have a substantially increased risk of [[hemorrhagic disease of the newborn]].<ref name=Harden/>

There is little evidence to suggest that anticonvulsant/ASM exposure through breastmilk has clinical effects on newborns. The [https://www.clinicaltrials.gov/study/NCT01730170 Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD)] study showed that most blood concentrations in breastfed infants of mothers taking carbamazepine, oxcarbazepine, valproate, levetiracetam, and topiramate were quite low, especially in relationship to the mother's level and what the fetal level would have been during pregnancy. (Note: valproic acid is NOT a recommended ASM for people with epilepsy who are considering having children.) <ref>{{cite journal |last1=Birnbaum |first1=Angela K. |last2=Meador |first2=Kimford J. |last3=Karanam |first3=Ashwin |last4=Brown |first4=Carrie |last5=May |first5=Ryan C. |last6=Gerard |first6=Elizabeth E. |last7=Gedzelman |first7=Evan R. |last8=Penovich |first8=Patricia E. |last9=Kalayjian |first9=Laura A. |last10=Cavitt |first10=Jennifer |last11=Pack |first11=Alison M. |last12=Miller |first12=John W. |last13=Stowe |first13=Zachary N. |last14=Pennell |first14=Page B. |last15=for the MONEAD Investigator Group |date=2020-04-01 |title=Antiepileptic Drug Exposure in Infants of Breastfeeding Mothers With Epilepsy |journal=JAMA Neurology |volume=77 |issue=4 |pages=441–450 |doi=10.1001/jamaneurol.2019.4443 |issn=2168-6149|doi-access=free |pmid=31886825 |pmc=6990802 }}</ref>

Infant exposure to newer ASMs (cenobamate, perampanel, brivaracetam, eslicarbazepine, rufinamide, levetiracetam, topiramate, gabapentin, oxcarbazepine, lamotrigine, and vigabatrin) via breastmilk was not associated with negative neurodevelopment (such as lower IQ and autism spectrum disorder) at 36 months.<ref>{{cite web |title=Norwegian Mother, Father and Child Cohort Study (MoBa) |url=https://www.fhi.no/en/ch/studies/moba/ |access-date=2023-10-11 |website=Norwegian Institute of Public Health |language=en |archive-date=12 October 2023 |archive-url=https://web.archive.org/web/20231012044149/https://www.fhi.no/en/ch/studies/moba/ |url-status=live }}</ref>

Several studies that followed children exposed to ASMs during pregnancy showed that a number of widely used ones (including lamotrigine and levetiracetam) carried a low risk of adverse neurodevelopmental outcomes (cognitive and behavioral) in children when compared to children born to mothers without epilepsy and children born to mothers taking other anti-seizure medications. Data from several pregnancy registries showed that children exposed to levetiracetam or lamotrigine during pregnancy had the lowest risk of developing major congenital malformations compared to those exposed to other ASMs. The risk of major congenital malformations for children exposed to these ASMs were within the range for children who were not exposed to any ASMs during pregnancy.<ref>{{cite journal |last1=Tomson |first1=Torbjörn |last2=Battino |first2=Dina |last3=Perucca |first3=Emilio |date=April 2019 |title=Teratogenicity of antiepileptic drugs |journal=Current Opinion in Neurology |volume=32 |issue=2 |pages=246–252 |doi=10.1097/WCO.0000000000000659 |issn=1473-6551 |pmid=30664067 |s2cid=58608931 |url=https://cdm21054.contentdm.oclc.org/digital/api/collection/IR/id/2527/download |access-date=31 December 2023 |archive-date=22 November 2023 |archive-url=https://web.archive.org/web/20231122193507/https://cdm21054.contentdm.oclc.org/digital/api/collection/IR/id/2527/download |url-status=live }}</ref>

People with epilepsy '''can''' have healthy pregnancies and healthy babies. However, proper planning and care is essential to minimize the risk of congenital malformations or adverse neurocognitive outcomes for the fetus while maintaining seizure control for the pregnant person with epilepsy. If possible, when planning pregnancy, people with epilepsy should switch to ASMs with the lowest teratogenic risk for major congenital malformations as well as the least risk of adverse neurodevelopmental outcomes (e.g., lower IQ or autism spectrum disorder). They should also work with their healthcare providers to identify the lowest effective ASM dosage that will maintain their seizure control while regularly checking medication levels throughout pregnancy.<ref>{{cite journal |last1=Pennell |first1=Page B. |last2=Karanam |first2=Ashwin |last3=Meador |first3=Kimford J. |last4=Gerard |first4=Elizabeth |last5=Kalayjian |first5=Laura |last6=Penovich |first6=Patricia |last7=Matthews |first7=Abigail |last8=McElrath |first8=Thomas M. |last9=Birnbaum |first9=Angela K. |last10=MONEAD Study Group |date=2022-04-01 |title=Antiseizure Medication Concentrations During Pregnancy: Results From the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) Study |journal=JAMA Neurology |volume=79 |issue=4 |pages=370–379 |doi=10.1001/jamaneurol.2021.5487 |pmid=35157004 |issn=2168-6149|pmc=8845026 }}</ref>

Data from studies conducted on women taking antiepileptic drugs for non-epileptic reasons, including depression and bipolar disorder, show that if high doses of the drugs are taken during the first trimester of pregnancy then there is the potential of an increased risk of congenital malformations.<ref>{{cite journal |last1=Jazayeri |first1=Dana |last2=Graham |first2=Janet |last3=Hitchcock |first3=Alison |last4=O'Brien |first4=Terence J. |last5=Vajda |first5=Frank J.E. |date=2018 |title=Outcomes of pregnancies in women taking antiepileptic drugs for non-epilepsy indications |journal=Seizure |volume=56 |pages=111–114 |doi=10.1016/j.seizure.2018.02.009 |issn=1059-1311 |pmid=29471258 |doi-access=free}}</ref>