Dual Therapy with Lamotrigine and Levetiracetam Safer Than Valproate Monotherapy in Pregnant People with Epilepsy

Valproate is an effective treatment for seizures in people with epilepsy, particularly generalized epilepsy. However, valproate use during pregnancy is associated with increased risk for major congenital malformations (MCMs) and adverse effects on fetal neurodevelopment. In a large population-based cohort study of nearly 8 million total pregnancies in Denmark, Finland, Iceland, Norway, Sweden, the U.S., and Australia between 2000 and 2020, investigators sought to (1) describe rates of first-trimester use of antiseizure medications (ASMs) that are potential alternatives to valproate and (2) determine whether certain ASM combinations resulted in lower risk for MCMs compared with valproate monotherapy.

The main ASMs included in the study were v…