AEDs in Pregnancy — RACP Adult Medicine MCQ

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EasyClinical PharmacologyAEDs in PregnancyRACP Adult Medicine

A 38-year-old woman with epilepsy well-controlled on sodium valproate 1000 mg BD is planning pregnancy. She asks about switching antiepileptic medication. What is the safest AED option if seizure type permits?

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Correct answer: E — Levetiracetam

Among antiepileptic drugs, levetiracetam and lamotrigine have the most favourable safety profiles in pregnancy, with the lowest rates of major congenital malformations. Levetiracetam has shown very low teratogenicity rates in pregnancy registries (<2%). Lamotrigine is also well-established but requires close monitoring due to increased clearance in pregnancy. Valproate carries the highest teratogenic risk (10%) and should be avoided. The switch should occur pre-conception with specialist guidance.

Reference: AMH – 2025 – Antiepileptics in Pregnancy; TGA – 2024 – Valproate Safety Update