Is Gabapentin Safe to Take During Pregnancy?

What does the evidence say about gabapentin during pregnancy?

1. A population-based cohort study of more than 1.7 million pregnancies, including 4,642 exposed to gabapentin in the first trimester, found no significant increase in overall major birth defects after statistical adjustment, with a relative risk of 1.07. 1
2. In that same cohort, people who filled two or more gabapentin prescriptions in the first trimester had a higher relative risk of a cardiac defect, 1.40, than the gabapentin-exposed group overall, including close to double the risk of a conotruncal heart defect specifically, 1.99. 1
3. Gabapentin may lower folic acid levels, and professional organizations disagree on whether extra folic acid supplementation is needed during gabapentin use, which is worth raising directly with your prescriber. 2
4. Gabapentin passes into breast milk in low levels, and the available case reports have not described adverse effects in breastfed infants whose parent was taking it. 3
5. Combining gabapentin with an opioid raises the risk of respiratory depression and sedation, which has occasionally been fatal, and gabapentin should be tapered gradually over a week or more rather than stopped abruptly, since sudden discontinuation can trigger withdrawal seizures. 4

Is gabapentin safe in each trimester?

• First trimester. Early pregnancy is when a possible small increase in certain heart defects has shown up in large database studies, especially among people who filled two or more gabapentin prescriptions. Overall major birth defect rates have not been higher across studies as a whole.
• Second trimester. Gabapentin is often continued through the second trimester for the same nerve pain, seizure, or migraine reasons it was started for. Ask your prescriber whether your folic acid dose needs adjusting, since gabapentin may lower folate levels and experts disagree on whether extra supplementation is needed.
• Third trimester. Exposure later in pregnancy has been linked to higher rates of preterm birth, smaller-than-expected size for gestational age, and NICU admission in the same large database study. If you are also taking an opioid, tell your delivery team, since the combination raises the chance of newborn withdrawal signs and of breathing problems for you.