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Is it safe? · Pregnancy Smart

Is Levetiracetam (Keppra) Safe During Pregnancy?

Assigned clinical reviewerMatt Stahl· PharmDDraft · pending clinical reviewUpdated

What does the evidence say about levetiracetam during pregnancy?

  1. The 2024 AAN, AES, and SMFM guideline says clinicians should consider levetiracetam, lamotrigine, or oxcarbazepine when appropriate to minimize major-malformation risk while maintaining seizure control. 1
  2. In the prospective EURAP registry, major congenital malformations occurred in 17 of 599 levetiracetam-monotherapy pregnancies, or 2.8%, compared with higher observed proportions for several older antiseizure medicines. 2
  3. A systematic review found 27 major congenital malformations among 1,213 levetiracetam-monotherapy pregnancies, 2.2%, versus 34 among 541 polytherapy pregnancies, 6.3%, but regimen and patient differences limit causal comparison. 3
  4. A 2024 monitoring cohort of 38 pregnant patients found that levetiracetam concentration per dose decreased during pregnancy and rose abruptly postpartum, supporting individualized level checks and a planned postpartum dose review. 4
  5. In a small EURAP neurocognitive extension, adjusted overall IQ scores at age 6 to 7 did not differ significantly across levetiracetam, lamotrigine, carbamazepine, and valproate groups, but only 18 children had levetiracetam exposure and one memory measure was lower. 5

Is levetiracetam safe in each trimester?

  • First trimester. Continue the prescribed regimen unless the epilepsy specialist changes it. Current AAN, AES, and SMFM guidance cautions against removing an effective medicine once pregnancy has begun and recommends at least 0.4 mg folic acid daily.
  • Second trimester. Levetiracetam clearance can rise and blood concentrations can fall as pregnancy progresses. Review seizure control, adherence, and individualized blood-level goals with neurology rather than changing the dose yourself.
  • Third trimester. Plan delivery and postpartum dosing before birth. A 2024 cohort found an abrupt postpartum concentration increase as pregnancy-related clearance reversed, and newborn observation may be appropriate after exposure near delivery.

Frequently asked questions

Is Keppra one of the safer seizure medicines during pregnancy?

Levetiracetam is one of the options current AAN, AES, and SMFM guidance says clinicians should consider when it fits the epilepsy syndrome and comorbidities. That recommendation reflects comparatively low observed malformation prevalence, not a guarantee of safety or a reason to switch a stable regimen after conception.

Does levetiracetam cause birth defects?

The EURAP registry recorded major malformations in 17 of 599 pregnancies exposed to levetiracetam alone at conception, or 2.8%. This prospective registry is reassuring relative to several other medicines, but it is observational and cannot exclude uncommon effects, dose effects, or differences between patient groups.

Can a baby have withdrawal symptoms from levetiracetam after birth?

A levetiracetam-specific newborn-withdrawal rate is not established. One retrospective study grouped anticonvulsants with several psychotropic drug classes, so it cannot isolate Keppra's effect. Tell the delivery and newborn teams about every medicine used near birth so they can plan observation based on the full regimen.

How much folic acid should you take with levetiracetam?

The current AAN, AES, and SMFM guideline recommends at least 0.4 mg of folic acid daily before conception and during pregnancy for anyone taking an antiseizure medicine. It does not support one higher universal dose. Ask neurology and obstetrics to individualize the amount instead of assuming 5 mg is required.

Why are levetiracetam blood levels checked during pregnancy?

Pregnancy increases levetiracetam clearance in many patients, so the same dose can produce a lower blood concentration. Monitoring against an individualized preconception or stable baseline can help neurology interpret breakthrough symptoms and dose needs. A laboratory population range is not a substitute for the patient's effective baseline.

Should levetiracetam be stopped after a positive pregnancy test?

No. Do not stop or reduce levetiracetam without urgent advice from the prescribing specialist. Convulsive seizures can endanger the pregnant person and fetus, and current guidance urges caution when changing a medicine that controls generalized tonic-clonic or focal-to-bilateral tonic-clonic seizures after pregnancy has begun.

Does the levetiracetam dose usually change during pregnancy?

Some patients need dose increases because levetiracetam concentrations fall, while others remain stable. In one 2024 cohort, average dosing rose during pregnancy and then fell postpartum, but that was not a universal schedule. Dose decisions should follow seizure history, side effects, adherence, and individual blood levels.

What happens to levetiracetam levels after delivery?

Levetiracetam clearance can reverse quickly after birth, causing blood concentrations to rise if the pregnancy dose continues unchanged. A postpartum plan should specify when levels will be checked, how symptoms will be watched, and whether neurology expects a stepwise dose reduction.

What do studies show about learning after levetiracetam exposure in pregnancy?

Long-term data are limited. A EURAP extension tested 18 levetiracetam-exposed children at ages 6 to 7. Adjusted overall IQ scores did not differ significantly across four medicine groups, but the levetiracetam group was small and had a lower delayed-name-memory score, so broad reassurance would be premature.

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References

  1. Teratogenesis, Perinatal, and Neurodevelopmental Outcomes After In Utero Exposure to Antiseizure Medication

    AAN, AES, and SMFM via PMC · https://pmc.ncbi.nlm.nih.gov/articles/PMC11175651/

  3. The fetal safety of Levetiracetam: a systematic review

    Reproductive Toxicology via PubMed · https://pubmed.ncbi.nlm.nih.gov/24602560/

  4. Therapeutic drug monitoring in pregnancy: Levetiracetam

    Epilepsia via PubMed · https://pubmed.ncbi.nlm.nih.gov/38400747/

  6. Evaluation of neonatal withdrawal syndrome in neonates delivered by women taking psychotropic or anticonvulsant drugs

    European Journal of Obstetrics & Gynecology and Reproductive Biology via PubMed · https://pubmed.ncbi.nlm.nih.gov/33011505/

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.