Antiepileptic use for psychiatric disorders in females of childbearing potential

Antiepileptics recommended in these guidelines for psychiatric disorders are sodium valproate, carbamazepine, pregabalin and lamotrigine.

For advice on hormonal contraceptive drug interactions (eg with carbamazepine and lamotrigine) and recommended actions and alternative contraceptive methods, see Drug interactions with hormonal contraceptives.

The data used to inform the below recommendations are taken from studies of females of childbearing potential with epilepsy; however, the risks attributed to the drugs below are expected to be similar in patients with psychiatric disorders.

Avoid sodium valproate in a female of childbearing potential because if pregnancy occurs, the risk of major malformations (including neural tube defects) is over 10% and the risk of developmental disorders, particularly lower intelligence quotient (IQ), is estimated to be between 30 and 40%Bromley 2014Weston 2016. If sodium valproate is the treatment of choice, ensure the patient understands these risks and uses effective contraceptionAustin 2017NICE 2018Weston 2016. Sodium valproate has also been associated with increased rates of polycystic ovary syndrome.

Although carbamazepine has been associated with an increased risk of congenital malformations, this risk is less than with sodium valproate—advise the patient about this risk and discuss the importance of effective contraception.

Pregabalin has limited safety data in pregnancy. If pregabalin is required, ensure the patient understands there is a potential risk of harm to the fetus and discuss effective contraception.

Lamotrigine has no clear link with adverse obstetric outcomes.

If a patient taking an antiepileptic wishes to plan a pregnancy: