Guidelines confirm safety of pregnancy in women who have epilepsy—with caveats

Healthy women can expect an uneventful pregnancy and delivery, provided they avoid valproate and refrain from smoking

Senior Editor

First-trimester exposure to the antiepileptic drug valproate increases the risk of major congenital malformation, particularly neural tube defects and facial clefts, according to recent guidelines developed by the American Academy of Neurology and the American Epilepsy Society.^1-3 The guidelines recommend that women who have epilepsy avoid taking valproate during pregnancy.

“Good evidence shows that valproate is linked to an increased risk for fetal malformations and decreased thinking skills in children, whether used by itself or with other medications,” said lead guideline author Cynthia Harden, MD, director of the Epilepsy Division at the University of Miami’s Miller School of Medicine and member of the American Academy of Neurology.