The safety of most seizure medications during pregnancy has not been established and it is important that women who are taking seizure medications consult with their physician before they attempt to get pregnant.

Women with epilepsy have a slightly higher risk (4 to 6 percent) of having a child with a birth defect than women without epilepsy (2 to 3 percent), according to the Epilepsy Foundation. This risk increases when pregnant women take certain seizure medications. The most common birth defects associated with seizure medications are spina bifida and cleft palate formation. The American Academy of Neurology recommends that women with epilepsy of childbearing age should take no less than 0.4 milligrams per day of folic acid and continue this during pregnancy. 

A physician may recommend that women modify their dosage level or taper off their medications before they become pregnant to reduce the risk of birth defects. If seizure medication withdrawal is planned, it should be done at least six months before conception. If medication withdrawal is not possible, therapy should be optimized before conception. During pregnancy, it is not recommended to switch to another anti-seizure medication for the sole purpose of avoiding birth defects. Women with epilepsy are advised to follow up regularly with their neurologist during pregnancy.

Some seizure medications may be passed to infants through breast milk. Women who are taking seizure medications may be advised by their physician to refrain from nursing or to wait several hours after taking their medications before nursing. It is important to discuss medication management with a physician before, during and after pregnancy.