• Posted July 24, 2025

Pregnant Women Turning To Safer Antiseizure Drugs

More pregnant women are turning to newer and potentially safer antiseizure medications, a new study says.

Older antiseizure drugs like valproate and phenobarbital are known to increase risk of birth defects.

But there’s been a 30% increase in the use of the safest antiseizure drugs during pregnancy, researchers report in the July 23 issue of Neurology.

“The good news is that use of the drugs with the greatest risks has decreased, and use of the safest drugs has increased, but we are concerned to still see use during pregnancy of some drugs with known risks and new drugs with uncertain risk,” senior researcher Dr. Rosemary Dray-Spira said in a news release. Dray-Spira is deputy director of the French National Agency for the Safety of Medicines and Health Products.

For the study, researchers analyzed more than 55,800 pregnancies in France between 2013 and 2021 in which the mother took at least one antiseizure medication.

“These medications can be used for epilepsy, mood disorders, chronic pain and migraine, which often occur at young ages, and sometimes people are taking them before they realize that they are pregnant,” Dray-Spira said.

Researchers placed the drugs in three safety categories:

• Safest – lamotrigine and levetiracetam.

• Uncertain risk – pregabalin, gabapentin, lacosamide and zonisamide.

• Known risk – valproic acid, valpromide, carbamazepine and topiramate.

Use of the safest drugs increased by 30% during the study period, researchers found. 

At the same time, use of valproic acid and valpromide decreased by more than 80%.

Exposure to the risky drugs carbamazepine and topiramate barely changed.

Researchers also found a 28% increase in use of the new drugs pregabalin and gabapentin, despite their uncertain risks, and exposure to these newer drugs increased over time.

“Despite a sharp shift from valproate to safer antiseizure medications, prenatal exposure to other ASMs with acknowledged or uncertain risks has persisted or even increased,” researchers concluded.

This study comes on the heels of another Neurology report earlier this month, which found that levetiracetam, oxcarbazepine, gabapentin and zonisamide do not show an increased risk for birth defects.

The July 16 report also confirmed that valproate, phenobarbital and topiramate increase the odds of major birth defects in infants.

More information

The Epilepsy Foundation has more on antiseizure medications in pregnancy.

SOURCES: American Academy of Neurology, news release, July 23, 2025; Neurology, July 23, 2025