Is Lamictal safe during pregnancy?

What does the evidence say about Lamictal during pregnancy?

1. Several studies covering several thousand pregnancies found no increased chance of birth defects with lamotrigine, a medication used for bipolar disorder and some types of seizures. 1
2. One study suggested a less than 1 percent increase in oral clefts such as cleft lip or palate, a finding other studies have not confirmed, and lamotrigine has not been linked to a higher chance of miscarriage. 1
3. Major congenital malformations occurred in 74 of 2,514 lamotrigine monotherapy pregnancies, or 2.9 percent, the second lowest rate among eight antiseizure medicines in the EURAP registry, and the rate increased with the dose taken at conception. 2
4. Average peak lamotrigine clearance rose 191 percent above the nonpregnant baseline across 115 pregnancies, with wide variation between individuals and even between repeat pregnancies in the same person. 3
5. Bipolar disorder is one of the conditions covered by ACOG's clinical practice guideline on mental health conditions in pregnancy and postpartum, which was written specifically to assess the evidence on psychiatric medications during pregnancy and lactation. 4

Is Lamictal safe in each trimester?

• First trimester. First-trimester data here is unusually good for a psychiatric medication. The EURAP registry recorded major malformations in 74 of 2,514 lamotrigine monotherapy pregnancies, or 2.9 percent, the second lowest of eight medicines compared, and the rate climbed with the dose taken at conception.
• Second trimester. Lamotrigine clearance rises steeply as pregnancy goes on, with average peak clearance up 191 percent from a nonpregnant baseline in one analysis. A stable dose can quietly become an underdose. Many clinicians check blood levels through this stretch for exactly that reason.
• Third trimester. Levels stay unpredictable late in pregnancy and then swing back after delivery, which makes postpartum dose planning as important as prenatal planning. A baby can be watched for a rash, breathing trouble, sleepiness, or poor sucking. Set that plan with your prescriber before you are in labor.