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 fact sheet talks about whether exposure to topiramate 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 topiramate?

Topiramate (Topamax®, Trokendi XR®, Qudexy XR®) is an antiepileptic medication used to prevent seizures and migraine headaches. It has also been used to treat alcoholism, eating disorders, tremors, obesity, diabetes and psychiatric disorders such as bipolar disorder. It is also part of a weight loss drug called Qysymia®. The use of topiramate at the same time as birth control medications may make the birth control product less effective. Please discuss this with your healthcare provider if you take topiramate and want to take birth control medications.

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

Each person’s ability to break down medication can be different, and may be affected by your age and other medications you may be taking. In general, it takes between 4 and 6 ½ days for most of the topiramate to leave your body. It is important that you not stop taking topiramate without first talking to your healthcare provider. It is important to discuss the risks and benefits to you from stopping the medication, as well as the potential risks from the untreated disease or symptoms during pregnancy.

If you are taking topiramate and you are planning a pregnancy, discuss a pregnancy treatment plan well in advance of getting pregnant. Women taking topiramate are advised to take a higher dose of folic acid (a B vitamin) before becoming pregnant to help lower the chance for birth defects. Talk to your healthcare provider about all of these issues.

I have been taking topiramate for many years. Can taking topiramate make it harder to become pregnant?

The effect of topiramate on a woman’s ability to conceive has not been well studied.

I have been taking topiramate and just found out I am pregnant. Should I stop?

You should not stop taking topiramate without first talking to your healthcare providers. The benefits of taking topiramate must be weighed against the potential risks to the pregnancy. Having a seizure or untreated depression in pregnancy may be harmful to both the pregnant woman and the baby. If your symptoms are well controlled on topiramate, and there are no other options that are better-studied, your health care provider may advise against changing or stopping your medication.

Can taking topiramate during my pregnancy cause birth defects?

Possibly. While most children born to women who take topiramate during pregnancy do not have a birth defect, there is a small increased chance for birth defects when taking topiramate in the first trimester. The chance for a birth defect might be affected by the dose of topiramate, the level of topiramate in the blood, whether topiramate is taken alone or in combination with other antiepileptic medications, and possibly other factors. Studies suggest that topiramate use in the first trimester can increase the chance that a baby will be born with a cleft lip and/or a cleft palate (split lip or opening in the roof of the mouth).

Can taking topiramate during my pregnancy cause other pregnancy complications?

Some studies have noticed that topiramate might be associated with babies being smaller than expected. This included babies measuring overall smaller and/ or low birth weights.

Will taking topiramate during pregnancy affect my baby’s behavior and development?

It is not known. One study included 9 pre-school aged children whose mothers took topiramate during pregnancy. This small study raised concerns that prenatal topiramate might have an effect on learning and motor coordination. The researchers were not able to be certain if the use of topiramate caused the problems with behavior and development in these children. Another small study looked at 27 children whose mothers took topiramate during pregnancy. This study did not notice problems in verbal abilities or IQ scores when testing these children between the ages of 5 and 9 years.

What could happen to my baby if I stopped taking my topiramate and then had a seizure during my pregnancy?

The effect of untreated seizures during pregnancy is not well-known, however, there is concern that untreated seizures could cause falls that could result in physical harm to both mother and developing baby.

Can I use topiramate while I am breastfeeding?

Probably. Topiramate can be found in breast milk; but babies exposed through breastfeeding usually have very low levels of topiramate in their systems. Side effects or harmful effects in the nursing baby are rarely reported. Your healthcare provider can help you make this decision depending on your dose, what other medications you are taking, and the health of your baby. In the unlikely event that you notice any changes in the baby, discuss with your pediatrician.

What if the father of the baby takes topiramate?

While some antiepileptic medications may cause abnormal sperm, resulting in infertility in men, there is no specific information on topiramate yet. In general, however, medications that a father takes do not increase the risks to a pregnancy. For more information, please see the MotherToBaby fact sheet about Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/pdf/.

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