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Levetiracetam in Pregnancy – Safety — SCE Neurology MCQ

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EasyEpilepsy & Seizure DisordersLevetiracetam in Pregnancy – SafetySCE Neurology

A 35-year-old woman with epilepsy on levetiracetam discovers she is 8 weeks pregnant. The pregnancy is planned and she is on folic acid 5 mg. Her epilepsy is well controlled. What advice should be given regarding levetiracetam and pregnancy?

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Correct answer: A — Continue levetiracetam — it has one of the lowest teratogenic risks of all AEDs; monitor drug levels as clearance increases in pregnancy

Levetiracetam has one of the lowest teratogenic risk profiles among AEDs (major congenital malformation rate ~2–3%, similar to the background population rate). It is considered one of the safer AEDs in pregnancy alongside lamotrigine. Drug levels should be monitored as renal clearance increases in pregnancy, potentially requiring dose adjustment. The pregnancy should be registered with the UK Epilepsy and Pregnancy Register. A: LEV is not significantly teratogenic. C: Valproate has the HIGHEST teratogenic risk — never switch to it in pregnancy. D: Reducing the dose risks breakthrough seizures. E: Phenobarbital has higher teratogenic risk.

Reference: NICE NG217 (2025); UK Epilepsy and Pregnancy Register; MHRA