A pregnant woman needs to be careful about nutrition because her baby eats whatever she eats. Developing fetuses are vulnerable, and a shortage of vital nutrients during pregnancy can lead to serious medical complications. In particular, pregnant women are urged to get plenty of folic acid to reduce the chance of birth defects. Some anti-epileptic drugs can reduce with folic acid levels, but women with epilepsy can't simply stop taking seizure medications. As of 2011, it is unknown whether the brand-name anticonvulsant drug Keppra reduces folic acid levels or not.
Importance of Folic Acid
Everyone needs folic acid, also known as vitamin B-9, because it helps the body produce new cells. Folic acid is particularly important for developing fetuses because a deficiency greatly increases the chance of a baby developing open neural tube defects, a class of birth defect which includes spina bifida. The Centers for Disease Control recommends that women take 400 mcg of folic acid per day, starting at least one month before becoming pregnant. The Office on Women's Health recommends folic acid from supplements rather than food because it is harder for the body to process natural sources than artificial sources.
Anti-Seizure Medications and Folic Acid
Pregnant women and their doctors need to be aware of medications that can reduce levels of folic acid, since higher supplemental doses may be necessary to ensure the baby's health. The article "Epilepsy in Women," published in "American Family Physician" by Martha J. Morrell, M.D., points out that older generations of anticonvulsants such as valproate, or Depakote, and carbamazepine, or Tegretol, will reduce folic acid in a pregnant woman's body. The University of Maryland adds phenytoin, or Dilantin, to that list.
Keppra and Folic Acid
Does the anticonvulsant levetiracetam, sold under the brand name Keppra, also reduce folic acid in pregnant women? As of 2011, doctors can't say for sure. Dr. Morrell says that laboratory testing has shown Keppra does not produce birth defects in animals, but there has not been enough testing on pregnant women to declare the drug completely safe.
Expert Insight
Keppra has not been proved harmless, but has not been proved dangerous, either. Pregnant women taking Keppra need to tell their neurologists when they become pregnant, and tell their obstetricians about the medications they are taking. The American Academy of Neurology has released guidelines on using antiepileptic drugs in pregnancy, which include using a single drug at the lowest effective dose, and adding folic acid supplements.
Pregnant women taking Keppra or other anticonvulsants should register with the North American Pregnancy Registry by calling 888-233-2334 or going to their website. This agency gathers information on pregnant women taking antiepileptic drugs so doctors can judge the safety of different therapies. (Reference 3)
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