From the Research
Lamotrigine can be used during pregnancy, but requires careful management and monitoring. Women who are pregnant or planning pregnancy should not stop taking lamotrigine suddenly as this could lead to seizures that may harm both mother and baby. Instead, they should consult their neurologist or obstetrician to develop a personalized treatment plan.
Key Considerations
- During pregnancy, lamotrigine blood levels often decrease due to increased metabolism and kidney clearance, potentially requiring dose adjustments.
- Regular blood level monitoring (typically monthly) is recommended, with dose increases as needed to maintain therapeutic levels.
- There is a small increased risk of birth defects (approximately 2-3% compared to 1-2% in the general population), particularly cleft lip and palate, as noted in studies such as 1.
- However, uncontrolled seizures during pregnancy pose greater risks to both mother and fetus.
- Folic acid supplementation (4-5 mg daily) is strongly recommended before conception and throughout pregnancy to reduce neural tube defect risk, as suggested by general prenatal care guidelines.
- After delivery, lamotrigine doses may need to be reduced as metabolism returns to pre-pregnancy levels.
- Lamotrigine does pass into breast milk, but breastfeeding is generally considered compatible with treatment as benefits typically outweigh risks.
Recent Evidence
A recent systematic review and meta-analysis 2 found that lamotrigine monotherapy had a slightly weaker ability to control seizures during pregnancy compared to other antiseizure medications, but it had a lower rate of adverse pregnancy outcomes.
Safety Profile
Compared to other antiepileptic drugs like carbamazepine, lamotrigine has been found to have a better safety profile during pregnancy, with lower risks of major malformations, as indicated in studies such as 3.
Clinical Decision
The decision to use lamotrigine during pregnancy should be made on a case-by-case basis, considering the individual's seizure control needs and the potential risks and benefits. As noted in 4, lamotrigine appears to be a reasonable alternative for pregnant women when clinically indicated, given its relatively favorable safety profile compared to other antiepileptic drugs.