When youâre taking medication to control seizures, the last thing you want to worry about is harming a baby youâre planning to have. But for women of childbearing age, this isnât just a hypothetical concern-itâs a daily reality. Seizure medications can affect fetal development, interfere with birth control, and create dangerous trade-offs between keeping seizures under control and protecting a growing child. The truth isnât simple. Some drugs are far riskier than others. And many people donât even know which ones theyâre taking-or what those risks really mean.
Some Seizure Medications Are Much Riskier Than Others
Not all antiseizure drugs are created equal when it comes to pregnancy. The biggest red flag is valproic acid (sold as Depakote, Epilim, or sodium valproate). Itâs one of the most effective drugs for stopping seizures, but itâs also one of the most dangerous for unborn babies. About 1 in 10 babies exposed to valproate during pregnancy develop major birth defects-things like spina bifida, heart problems, cleft lip or palate, and microcephaly (a smaller-than-normal head size). Thatâs more than double the risk seen with most other seizure medications.
Valproate doesnât just cause physical defects. Children exposed to it in the womb are also more likely to be diagnosed with autism spectrum disorder or ADHD later in life. A 2020 study in Neurology found these kids had nearly twice the risk of ADHD and more than double the risk of autism compared to those exposed to other seizure drugs.
Other high-risk drugs include phenytoin (Epanutin), phenobarbital, carbamazepine (Tegretol), and topiramate (Topamax). These can also lead to heart defects, facial abnormalities, and developmental delays. The risk increases with higher doses. For example, the more carbamazepine a woman takes during early pregnancy, the greater the chance of a major congenital malformation.
But hereâs the good news: not all seizure medications carry these risks. Lamotrigine (Lamictal) and levetiracetam (Keppra) are now considered the safest options during pregnancy. Studies tracking over 298 children exposed to these drugs before birth found no significant difference in language development at age two compared to children whose mothers didnât take any seizure meds. These newer drugs donât just work-they work without the same level of danger.
The Big Picture: Most Babies Are Still Healthy
Itâs easy to feel overwhelmed by the numbers. But remember: over 90% of babies born to women with epilepsy are born without major birth defects. Thatâs not a small margin-itâs a powerful reminder that with the right care, you can have a healthy pregnancy even while managing seizures.
Between 1997 and 2011, the rate of major congenital malformations dropped by 39%. Why? Because doctors started prescribing safer drugs more often. More women got preconception counseling. More people switched from valproate to lamotrigine or levetiracetam before getting pregnant. This wasnât luck-it was better medicine.
Still, not everyone benefits from these improvements. A French study found that women with lower incomes or less access to healthcare were more likely to be prescribed high-risk drugs like valproate during pregnancy. This isnât about personal choices-itâs about systemic gaps. If youâre struggling to get the right care, youâre not alone. But youâre not powerless, either.
Drug Interactions Can Sabotage Your Birth Control
Hereâs something many women donât realize: your seizure medication might be making your birth control useless. Carbamazepine, phenytoin, phenobarbital, oxcarbazepine, and high doses of topiramate can speed up how your body breaks down hormones. That means birth control pills, patches, or rings might not work as well-or at all.
And it goes both ways. Hormonal contraceptives can lower the levels of certain seizure drugs in your blood. Lamotrigine, valproate, zonisamide, and rufinamide can become less effective if youâre on the pill. That means more seizures. More risk. More danger.
This isnât a minor side effect. Itâs a medical emergency waiting to happen. A 2023 study from AESNET found that two out of three women of childbearing age got the wrong advice about these interactions. Some were told their birth control was fine-even though they were on carbamazepine. Others didnât know their seizure meds could drop in effectiveness.
If youâre using hormonal birth control and taking any of these drugs, talk to your doctor about alternatives. Intrauterine devices (IUDs), especially non-hormonal copper IUDs, are often the safest bet. Implants and injections may also work better than pills. Donât assume your OB-GYN or neurologist already knows this. Bring it up. Ask specifically: âCould my seizure meds interfere with my birth control?â
Uncontrolled Seizures Are Even More Dangerous
Itâs tempting to think: âIf these drugs are so risky, Iâll just stop taking them.â Thatâs the worst thing you could do.
Tonic-clonic seizures-those violent, full-body convulsions-can cause miscarriage, placental damage, broken bones, and even death for both mother and baby. A seizure during labor can lead to oxygen deprivation. Falling during a seizure can cause trauma. The risk isnât theoretical. Itâs real, immediate, and far more common than birth defects from medication.
As Dr. Kelsey Wiggs from Indiana University put it, women face an âexcruciating double bind.â You need the medicine to survive. But the medicine might hurt your baby. Thereâs no perfect answer-only the best possible choice.
The American Epilepsy Society is clear: No seizure medication is as dangerous as uncontrolled seizures. Stopping your meds without medical guidance is never safe. The goal isnât to eliminate all risk-itâs to minimize the biggest risks.
What You Should Do Before Getting Pregnant
If youâre planning a pregnancy-or even thinking about it-donât wait. Talk to your neurologist now. Hereâs what you need to do:
- Review your current medication. If youâre on valproate, phenobarbital, phenytoin, or high-dose topiramate, ask if switching to lamotrigine or levetiracetam is possible. Many people can make the switch safely with careful monitoring.
- Get your dose optimized. The lowest effective dose is always best. Higher doses mean higher risks. Your doctor should aim for seizure control with the smallest amount of drug needed.
- Check your birth control. If youâre using pills, patches, or rings, ask if theyâre still effective with your meds. Consider switching to an IUD or implant.
- Start taking folic acid. At least 0.4 mg daily, and often up to 4 mg if youâre on high-risk meds. Folic acid reduces the risk of neural tube defects like spina bifida.
- Get a preconception counseling appointment. This isnât optional. Itâs essential. Find a specialist who understands epilepsy and pregnancy. Many hospitals have dedicated epilepsy-in-pregnancy clinics.
These steps donât guarantee a perfect outcome. But they dramatically improve your odds. Women who plan ahead have significantly fewer birth defects and better pregnancy outcomes.
What If Youâre Already Pregnant?
If youâre already pregnant and taking a high-risk medication, donât panic. Donât stop cold turkey. Call your doctor immediately.
Switching medications during pregnancy is possible-and often safer than continuing a high-risk drug. But it must be done slowly and under close supervision. Abrupt changes can trigger seizures, which are far more dangerous than adjusting your meds.
Your doctor will likely:
- Check your drug levels in your blood
- Adjust your dose gradually
- Monitor your baby with detailed ultrasounds
- Recommend additional prenatal testing if needed
Even if youâve been on valproate for years, switching to lamotrigine in the first trimester can still reduce the risk to your baby. Itâs not too late. But you need to act fast.
The Future Is Getting Safer
The landscape is changing. Newer drugs like cenobamate, ezogabine, and perampanel are still being studied, but early data looks promising. The number of high-risk prescriptions during pregnancy has dropped steadily over the past two decades. More women are being offered safer options. More doctors are asking about family planning.
Stanford neurologist Kimford Meador says women with epilepsy should now feel âbetter about their opportunities and options for having a child.â Thatâs a big shift from the 1950s, when women were told not to marry or have kids at all.
But progress isnât universal. If youâre in a low-income community, or your doctor doesnât specialize in epilepsy, you might still be stuck with outdated advice. Thatâs why knowledge matters. You have the right to ask, to demand better, to get the safest possible care.
Frequently Asked Questions
Can I take seizure meds while breastfeeding?
Yes, most seizure medications are safe during breastfeeding. Lamotrigine and levetiracetam pass into breast milk in very small amounts and are generally considered safe. Valproate and phenobarbital are present in higher levels, so they require more caution-but even then, many mothers breastfeed successfully with close monitoring. Always talk to your doctor before making a decision.
Do I need to take more folic acid if Iâm on seizure meds?
Yes. Women taking antiseizure medications should take at least 0.4 mg of folic acid daily before conception and during early pregnancy. If youâre on valproate, carbamazepine, or phenytoin, your doctor may recommend 4 mg daily. Folic acid helps prevent neural tube defects like spina bifida, which are more common with these drugs.
Are generic versions of seizure meds just as safe?
Not always. For some drugs-especially phenytoin and carbamazepine-generic versions can cause unpredictable changes in blood levels, which may trigger seizures or increase side effects. If youâre pregnant or planning to be, your doctor may recommend sticking with the brand-name version to keep levels stable. Donât switch generics without consulting your neurologist.
Can men taking seizure meds affect their partnerâs pregnancy?
Current evidence suggests that seizure medications taken by men do not increase the risk of birth defects in their children. The main risks come from the motherâs medication use during pregnancy. However, if a man is on high-dose valproate, some doctors recommend discussing fertility concerns, as it may slightly reduce sperm quality. This is not a major concern for most men, but itâs worth mentioning if youâre planning a family.
What if I canât switch to a safer medication?
If youâve tried other meds and they donât work, your doctor may still recommend staying on a higher-risk drug-but with extra precautions. This includes higher folic acid doses, more frequent ultrasounds, and possibly amniocentesis to check for birth defects. The goal is to minimize risk as much as possible while keeping seizures controlled. Never stop your meds without medical help.
Next Steps: What to Do Today
If youâre a woman of childbearing age taking seizure medication:
- Check your current drug name. Is it valproate, phenytoin, or topiramate? If yes, schedule an appointment with your neurologist this week.
- Review your birth control. Are you on the pill? Patch? Ring? Ask if itâs still effective with your meds.
- Start taking folic acid if youâre not already. Even if youâre not trying to get pregnant now, itâs a simple step that could protect your future.
- Find a specialist. Look for a neurologist who works with epilepsy and pregnancy. Hospitals in Boston, like Mass General and Brigham and Womenâs, have dedicated clinics.
- Talk to your partner. This isnât just your decision. Your support system matters.
Managing seizures during pregnancy isnât about perfection. Itâs about making smart, informed choices. Youâre not alone. And with the right care, you can have the healthy pregnancy you deserve.
Emma Hooper
December 31, 2025 AT 17:09I was on Depakote for years and switched to Lamictal before trying to conceive-best decision of my life. My daughter is now 3 and hitting every milestone. Also, folic acid? Non-negotiable. I took 4mg daily like my neuro told me. No regrets. đ
Martin Viau
January 1, 2026 AT 22:32Canadaâs healthcare system still doesnât prioritize preconception counseling for epilepsy patients. My sister got stuck on valproate because her neurologist âdidnât have time.â This isnât medical advice-itâs systemic neglect. We need policy changes, not just blog posts.
Marilyn Ferrera
January 2, 2026 AT 06:22Uncontrolled seizures > medication risks. Always. And folic acid isnât optional-itâs armor.
Deepika D
January 4, 2026 AT 00:32Hey everyone-just wanted to share my story. Iâm from India, diagnosed with epilepsy at 16, and was on phenobarbital for over a decade. When I got engaged, my husband and I were terrified. We didnât even know about the birth control interactions! But we found a specialist in Bangalore who connected us with a global epilepsy-in-pregnancy network. I switched to levetiracetam, started 5mg folic acid, got a copper IUD, and now Iâm 28 weeks pregnant with zero complications. I know it feels overwhelming, but youâre not alone. There are doctors out there who care. Reach out. Ask. Advocate. Your baby deserves a fighting chance-and so do you. Youâve got this. đŞâ¤ď¸
Branden Temew
January 5, 2026 AT 21:50So let me get this straight-weâre telling women to risk seizures to avoid birth defects⌠but the real danger is⌠doctors not knowing the drugs they prescribe? Wow. We really outdid ourselves.
Frank SSS
January 7, 2026 AT 02:34Iâve seen too many women get gaslit by OB-GYNs who think âepilepsy medsâ are just âregular pills.â My cousin lost two pregnancies because her doctor told her âthe pill should still workâ while she was on carbamazepine. Then she got blamed for ânot being careful.â No. The system failed her. And itâs still failing thousands.
Paul Huppert
January 8, 2026 AT 06:45Thanks for this. I didnât know lamotrigine was safe in pregnancy. My neuro never mentioned it. Iâll schedule a consult this week.
Hanna Spittel
January 9, 2026 AT 09:58Valproate = baby destroyer. Also, if your doctor doesnât know about the birth control thing⌠RUN. đ¨
Brady K.
January 9, 2026 AT 11:47Letâs be real-this isnât a âmedical issue.â Itâs a gendered healthcare failure. Women with epilepsy are expected to optimize their bodies for reproduction while being treated like walking liability reports. The fact that we still need a 5-step checklist to not have our babies genetically sabotaged by outdated protocols? Thatâs not progress. Thatâs a damn indictment.