Why Take Lyrica and Other Anticonvulsant Drugs Associated with Birth Defects?

Washington, DCNot all anti-epileptic drugs (AEDs) are made equal. Some AEDs, including Lyrica, are known to be associated with more birth defects than others. So why are they prescribed to pregnant women and/or women who may get pregnant?

The latter question is raised because some women don’t realize they are pregnant until late in their first trimester or even second trimester, at a time when the baby’s organs are developing, and also a time when most fetal malformations occur. Particularly epileptic women, because a number of symptoms of epilepsy are similar to the symptoms of pregnancy, according to the American Pregnancy Association.

Most epileptic women give birth to normal, healthy children. The National Institute of Neurological Disorder and Stroke (NINDS) estimates epilepsy affects 1 percent of the US population, or 2.5 million people. And the Epilepsy foundation states that about 1.1 million women with epilepsy in the US are of childbearing age. With a birth rate of 3-5 per 1000 births, approximately 24,000 babies are born to women with epilepsy each year. 

Fortunately the risk of seizure declines or remains the same for most women during pregnancy, although seizure risks include trauma from falls or burns, premature labor, miscarriages, and lowering of the fetal heart rate. And for those women taking certain anticonvulsant medications there is the risk of birth defects.

One study conducted in Norway found that pregnant women with epilepsy had a lower risk of complications but an increased risk of induction, cesarean delivery, and postpartum hemorrhage. The study did not determine whether the increased risks were a result of anticonvulsant medications or severe epilepsy. But one thing is clear: both seizures and medications are associated with some risk and the benefits of medications must be weighed carefully.

More than 20 different AEDs are on the market, and some of the newer anticonvulsants are better tolerated than the older AEDs. And some anti-seizure drugs have a higher incidence of birth defects. Valproate (known as Depakote) is the riskiest. If used in the first 28 days of pregnancy carries a 1-2 percent risk of neural tube defects or lack of spinal cord closure, and research from the NEAD study (Neurodevelopmental Effects of Anti-epileptic Drugs) found that women taking valproic acid during pregnancy had children with lower IQ (average 92, which is six points lower than average) and increased risk of autism. Depakote also hikes the risk of spina bifida and other structural deformities to about 10 percent.

Compared with Depakote, the newer generation AEDs, including Lyrica (Pregabalin), are safer, i.e., better tolerated, than the older generation anti-epileptic drugs that include phenobarbital and valproate. However, only a few studies have compared the newer to older generation medications and they haven’t included comparisons of birth defects associated with the drugs. Suffice to say, Lyrica fared better than other anticonvulsants on the study’s adverse effects and safety profiles.