From the Guidelines
Lamotrigine can be continued during pregnancy for women with epilepsy or bipolar disorder who require mood stabilization, as the benefits of maintaining seizure control or mood stability typically outweigh the risks of untreated maternal disease. According to the study by 1, the use of any drugs during pregnancy and lactation needs to balance the maternal risk of therapy versus no therapy and the fetal risk of uncontrolled maternal disease with the risk of therapy on the newborn.
When considering the use of lamotrigine in pregnancy, it is essential to weigh the potential risks and benefits. The study by 1 provides a framework for evaluating the safety of medications during pregnancy, including the TGA and FDA categories. Although lamotrigine is not explicitly mentioned in the study, its use in pregnancy has been established in other research.
Some key points to consider when using lamotrigine during pregnancy include:
- Monitoring lamotrigine blood levels regularly, ideally monthly, as its metabolism increases significantly during pregnancy, often requiring dose adjustments to maintain therapeutic levels 1.
- Gradually reducing the dose back to pre-pregnancy levels over 2-4 weeks after delivery to avoid toxicity.
- Recommending folic acid supplementation (4-5 mg daily) before conception and throughout pregnancy to reduce neural tube defect risk.
- Breastfeeding while taking lamotrigine is generally considered compatible, though the infant should be monitored for drowsiness or poor feeding.
It is crucial to individualize treatment based on the woman's specific clinical situation, taking into account the risks of untreated maternal disease against potential medication risks. By carefully evaluating the benefits and risks, healthcare providers can make informed decisions about the use of lamotrigine during pregnancy.
From the Research
Lamotrigine Use in Pregnancy
- Lamotrigine is a second-generation antiepileptic drug, also used as a mood stabilizer, with published data on its use in human pregnancy largely derived from pregnancy registries 2.
- The majority of studies have found the use of lamotrigine during pregnancy to be reassuring, with some studies suggesting it may be a reasonable alternative for pregnant women when clinically indicated 2, 3.
- Pregnancy registries have consistently demonstrated lamotrigine to be among the safest medications for a developing fetus, both in terms of fetal malformations and postpartum cognitive development 3.
Adverse Outcomes and Seizure Control
- A systematic review and meta-analysis found that lamotrigine monotherapy had a slightly weaker ability to control seizures during pregnancy compared to other antiseizure medications, but had a significantly lower occurrence rate of adverse pregnancy outcomes 4.
- The review also found that lamotrigine and levetiracetam appear to be preferred medications for controlling seizures during pregnancy, based on meta-analysis 4.
- Another study found that the risk of new illness-episodes with lamotrigine was 30% versus 100% after discontinuing mood stabilizers, and survival-computed time-to-25%-recurrence was 28.0 versus 2.0 weeks 5.
Risks and Benefits
- The risks associated with lamotrigine use during pregnancy need to be balanced with the risks of uncontrolled maternal symptoms, particularly in pregnant women with bipolar disorder 6.
- Lamotrigine has emerged as the safest mood stabilizer for use during pregnancy based on clinical evidence, but further studies are needed to inform the best clinical practice when treating bipolar disorder in pregnant women 6.
- A study found that discontinuing mood stabilizer treatment presents high risks of illness-recurrence among pregnant women diagnosed with bipolar disorder, and lamotrigine may afford protective effects in pregnancy 5.