In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. This sheet talks about whether exposure to lamotrigine may increase the risk for birth defects over that background risk. This information should not take the place of medical care and advice from your health care provider.

What is lamotrigine?

Lamotrigine is a medication that is used to treat some types of epilepsy (medical condition with seizures). It is also used to treat psychiatric disorders. A common brand name for lamotrigine is Lamictal®.

I have been taking lamotrigine for many years. Can this affect my ability to get pregnant?

Studies have found that the long-term use of seizure medications in women with a seizure disorder might be associated with irregular periods and difficulty getting pregnant (infertility). There are no studies on how lamotrigine might affect fertility.

I am taking lamotrigine, but I would like to stop taking it before I become pregnant. How long does lamotrigine stay in your body?

Each person’s ability to break down the medication may be different. If you are only taking lamotrigine, most of the lamotrigine should be gone from your body 5-7 days after your last dose. This timing could be different if you are taking other medications such as valproic acid, which may affect how your body breaks down lamotrigine.

Women should speak with their health care provider before making changes to their medication during pregnancy. Having a seizure while pregnant may be harmful to the baby. Women with bipolar disorder or depression who stop taking medications during their pregnancy are at increased risk for episodes of depression or mania that may be harmful to both the mother and the baby.

Women with seizure disorders or psychiatric disorders who could become pregnant should discuss their options for treatment, including medications, with their health care provider before becoming pregnant.

Women should also discuss starting folic acid supplements with their health care provider prior to becoming pregnant. Folic acid is a B group vitamin. All women planning a pregnancy should take folic acid as it has been shown to reduce the risk of having a baby with birth defects such. Because lamotrigine can affect the way the body handles folic acid your health care provider might discuss taking a higher than normal dose of folic acid for at least 1 month before trying to become pregnant and for the first 12 weeks of pregnancy.

Can taking lamotrigine during my pregnancy cause birth defects?

Most studies find no increase in birth defects among women taking lamotrigine in the first trimester of their pregnancy. There have been several large studies (looking at several thousand pregnancies) that have found no increase in birth defects. One study suggested a less than 1% increase in oral clefts (split in the lip and/or roof of the mouth). The use of more than one seizure medication, in particular valproic acid, along with lamotrigine, appears to be associated with an increased chance of birth defects.

However, it is important to remember that having a seizure or untreated psychiatric illness can be harmful to both mother and baby and therefore you should not stop or change your medication in pregnancy without speaking with your health care provider.

Can taking lamotrigine during pregnancy affect my baby’s development after birth?

A number of studies examining the development of babies who were exposed to lamotrigine during pregnancy have found no major difference in development between babies exposed to lamotrigine and those who were not. More studies are needed before we can be sure of the long-term effects of lamotrigine.

What else should I know about taking lamotrigine during pregnancy?

During pregnancy, women may need to increase their dose of lamotrigine in order to keep medicine levels at the right dose to work for them. Your health care provider can order blood tests while you are pregnant to check the levels of medicine in your body. Your dose of lamotrigine may need to be changed according to the results of these blood tests. If you need to increase your lamotrigine dose during pregnancy, the dose of lamotrigine will then need to be reduced after your baby is born to avoid the side effects of too high a dose.

Can I take lamotrigine while breastfeeding?

Lamotrigine can get into breast milk and then the baby’s body, likely at higher levels than with other seizure medication use while nursing. If you increased your lamotrigine dose in pregnancy, work with your health care provider to bring your dose down to proper levels for you. While the effect of lamotrigine in a nursing newborn is not clearly known, there are several reports of healthy nursing infants. There is a single report of breathing problems in a 16 day old infant whose mother was taking 850 mg/day of lamotrigine. However, most infants have no reported side effects. If you are taking lamotrigine you may choose to breastfeed your baby, but watch for possible side effects, such as a rash, sleepiness, or poor sucking. This is especially true for small, sick or premature babies. If you notice anything unusual in your nursing infant discuss the symptoms with your health care provider right away.

What if the father of the baby takes lamotrigine?

There are no studies looking at effects on a pregnancy if a father takes lamotrigine. In general, exposures that fathers have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet on Paternal Exposures and Pregnancy at http://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/pdf/.

References Available By Request