Antiseizure Meds With Known or Uncertain Risks Continue to Be Prescribed in Pregnancy

MONDAY, July 28, 2025 (HealthDay News) — Despite a shift from valproate to safer antiseizure medications (ASMs) in pregnancy, many medications with known or uncertain risks are still being prescribed, according to a study published online July 23 in Neurology.

Pouneh Shahriari, from the French National Agency for the Safety of Medicines and Health Products in Saint-Denis, France, and colleagues examined trends in prenatal exposure to ASMs in a nationwide, population-based study. The study included 55,801 ASM-exposed pregnancies that ended between 2013 and 2021.

The researchers observed a 30 percent increase in pregnancies exposed to the safest ASMs (lamotrigine and levetiracetam). Prenatal exposure to ASMs with acknowledged risk, including valproic acid and valpromide, decreased due to a reduction in the number of exposed pregnancies (−84 and −89 percent, respectively), an increasing termination rate of exposed pregnancies (+23 and +28 percent, respectively), and among those pregnancies that ended in childbirth, reduced numbers with multiple dispensations (−86 and −93 percent, respectively) or sustained exposure (−91 and −96 percent, respectively) throughout pregnancy. There was almost no decrease in prenatal exposure to carbamazepine and topiramate, which have acknowledged risk, with almost 600 newborns still exposed to each of these in 2019 to 2021. ASMs with uncertain risk, including pregabalin and gabapentin, became widely used during pregnancy.

“These disparities could be due to various factors, including more frequent unplanned pregnancies and suboptimal care before conception or during pregnancy for people who are socioeconomically disadvantaged,” coauthor Rosemary Dray-Spira, M.D., Ph.D., also from the French National Agency for the Safety of Medicines and Health Products, said in a statement. “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.”

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