Epilepsy in pregnancy
Preconception choice of antiseizure medication, teratogenic and neurodevelopmental risks by drug, falling drug levels in pregnancy, contraception interactions, seizures versus eclampsia, birth, breastfeeding and postpartum safety.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- About 1 in 200 pregnancies involve a woman with epilepsy. Epilepsy is among the leading indirect causes of maternal death, mostly SUDEP, so seizure control counts as much as drug choice.
- Plan before conception. Choose the drug and dose to suit both seizure control and the fetus, at the lowest effective dose. Most pregnancies are unplanned.
- Valproate carries the highest risk: about 10% major malformations and lower IQ and higher autism rates in exposed children. Avoid it in women who could become pregnant unless nothing else works.
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Sources
- Teratogenesis, perinatal, and neurodevelopmental outcomes after in utero exposure to antiseizure medication: practice guideline from the AAN, AES, and SMFMPack AM et al. Neurology 2024;102(11):e209279 (erratum: Neurology 2025;104(1):e210145), 2024
- Therapeutic Guidelines: Neurology (epilepsy in women of childbearing potential and pregnancy)AU/NZTherapeutic Guidelines Limited
- Balancing foetal disadvantage and seizure freedom in women capable of pregnancy, the Australian Pregnancy Register experienceAU/NZVajda F, O'Brien TJ, Graham J, et al. Epilepsy Behav 2025, 2025
- Australian Pregnancy Register of Antiepileptic DrugsAU/NZAustralian Pregnancy Register
- Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registryTomson T et al. Lancet Neurol 2018;17:530-38, 2018
- Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study)Meador KJ et al. Lancet Neurol 2013;12:244-52, 2013
- TGA safety updates: topiramate product information update on neurodevelopmental risk and use in women of childbearing potentialAU/NZTherapeutic Goods Administration, date of the topiramate update not confirmed; check the current PI
- Topiramate (Topamax): introduction of new safety measures, including a pregnancy prevention programmeMHRA Drug Safety Update, 2024
- Mazza D et al. Emergency contraception: an overview. Aust Prescr 2026;49(3) (with CYP3A4 inducers, copper IUD or double-dose 3 mg levonorgestrel)AU/NZAustralian Prescriber, 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy