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Lamictal during pregnancy

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  • Lamictal during pregnancy

    I’ve read contradicting research on lamictal during pregnancy. Going off of the medication is not an option.

    Is it suggested to take more folate during pregnancy or has this shown to limit the effects of lamictal?

    Third drug is being used to treat bpd, not epilepsy in case that makes a difference in recommendation.

  • #2

    Unlike other anticonvulsants, Lamictal is not known to reduce plasma folic acid levels in humans, but it does in animals. At this time we do not consider it teratogenic. Below is from the package insert. Note, they have a pregnancy registry. Please contact them and report outcome of your pregnancy. This will help other moms make the decision concerning lamotrigine. Below they report some birth defects, but remember, 2-4% of ALL pregnancies have some sort of birth defect, hence the 2% below is within the normal range.

    I would suggest that you take Folic acid anyway, as should all pregnant women.

    Tom Hale PhD

    From Package Insert:

    Human Data: Data from several international pregnancy registries have not shown an increased risk for malformations overall. The International Lamotrigine Pregnancy Registry reported major congenital malformations in 2.2% (95% CI: 1.6%, 3.1%) of 1,558 infants exposed to lamotrigine monotherapy in the first trimester of pregnancy. The NAAED Pregnancy Registry reported major congenital malformations among 2.0% of 1,562 infants exposed to lamotrigine monotherapy in the first trimester. EURAP, a large international pregnancy registry focused outside of North America, reported major birth defects in 2.9% (95% CI: 2.3%, 3.7%) of 2,514 exposures to lamotrigine monotherapy in the first trimester. The frequency of major congenital malformations was similar to estimates from the general population.

    The NAAED Pregnancy Registry observed an increased risk of isolated oral clefts: among 2,200 infants exposed to lamotrigine early in pregnancy, the risk of oral clefts was 3.2 per 1,000 (95% CI: 1.4, 6.3), a 3-fold increased risk versus unexposed healthy controls. This finding has not been observed in other large international pregnancy registries. Furthermore, a case-control study based on 21 congenital anomaly registries covering over 10 million births in Europe reported an adjusted odds ratio for isolated oral clefts with lamotrigine exposure of 1.45 (95% CI: 0.8, 2.63).

    Several meta-analyses have not reported an increased risk of major congenital malformations following lamotrigine exposure in pregnancy compared with healthy and disease-matched controls. No patterns of specific malformation types were observed.

    The same meta-analyses evaluated the risk of additional maternal and infant outcomes including fetal death, stillbirth, preterm birth, small for gestational age, and neurodevelopmental delay. Although there are no data suggesting an increased risk of these outcomes with lamotrigine monotherapy exposure, differences in outcome definition, ascertainment methods, and comparator groups limit the conclusions that can be drawn.