Pregnancy, baby, and childhood outcomes from using anti-seizure medication during pregnancy

Evidence of the safety of some anti-seizure medicines (ASMs) during pregnancy remains uncertain. We conducted a population-based cohort study of singleton pregnancies in Scotland conceived between 01/04/2010-02/07/2023. Exposure was ‘any ASM’ prescription issued 28 days prior to conception up to pregnancy end. Seven monotherapies were also examined: valproate, topiramate, carbamazepine, lamotrigine, levetiracetam, gabapentin and pregabalin. Unexposed comparators were matched to the exposed on gestational age and year of conception. Pregnancy loss, congenital condition and child development outcomes were compared by exposure status using conditional logistic regression to account for the matched study design. Here we show pregnancy loss (3175/11,011 pregnancies, 28.8% vs. 24,040/107,889 pregnancies, 22.3%), congenital conditions (230/8370 babies, 2.7% vs. 1693/82,085 babies, 2.1%) and developmental concerns (1270/4890 live births, 26.0% vs. 7658/48,883 live births, 15.7%) are more common following any ASM exposure in pregnancy compared with no ASM exposure in pregnancy. Valproate is strongly associated with pregnancy loss (adjusted odds ratio (aOR): 1.92, 95% confidence interval (CI): 1.50-2.47), congenital conditions (aOR: 1.85, 95% CI: 1.06-3.21) and developmental concerns (aOR: 1.43, 95% CI: 1.01-2.03). Pregabalin, gabapentin and any ASM are also associated with pregnancy loss and developmental concerns. Our findings corroborate the associated risks of valproate use and embryo malformations, support the use of lamotrigine and levetiracetam in pregnancy and raise concerns regarding gabapentinoid use in pregnancy. Moore et al. examine whether taking certain anti-seizure medications (ASMs) during pregnancy affects the health of the baby or the pregnancy. Findings reveal that taking ASMs—especially valproate, pregabalin and gabapentin—is linked to higher rates of pregnancy loss and developmental concerns in children. This study looked at the safety of taking anti-seizure medications (ASMs) during pregnancy. We studied over 900,000 pregnancies, comparing outcomes in those which did, and did not, receive ASMs. ASMs (especially valproate, pregabalin, and gabapentin) were linked to pregnancy loss and developmental concerns and (valproate) congenital conditions. Lamotrigine and levetiracetam appeared to be safer options. Our findings reinforce the known risks of valproate during pregnancy and raise concerns about pregabalin and gabapentin. Whilst our study demonstrates potential risks associated with taking some anti-seizure medications in pregnancy, there can also be risks associated with suddenly stopping these medicines, for example, worsening of seizure control. It is therefore important that women do not suddenly stop or change their medications without medical advice.