(Date of issue: November 2014. Version: 2)
This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.
What is it?
Gabapentin (Neurontin®, Segosana®) is used to treat epilepsy, certain types of nerve pain and to prevent migraine. It is sometimes taken in combination with other medicines.
Is it safe to take gabapentin in pregnancy?
There is no yes or no answer to this question. When deciding whether or not to take gabapentin during pregnancy it is important to weigh up how necessary gabapentin is to your health against the possible risks to you or your baby, some of which will depend on how many weeks pregnant you are. Remaining well is particularly important during pregnancy and whilst caring for a baby. It is vital that epilepsy is well-controlled during pregnancy as seizures can harm both the mother and unborn child. For some pregnant women treatment with gabapentin may be necessary.
It is recommended that all women taking anti-epileptic medicines also take high dose folic acid (5mg/day) whilst trying to conceive and during the first trimester of pregnancy. High dose folic acid has to be prescribed by a doctor. For more information, please see the folic acid bumps leaflet.
This leaflet summarises the scientific studies relating to the effects of gabapentin on a baby in the womb. It is advisable to consider this information if you are taking gabapentin and are pregnant or could become pregnant in the future.
Your doctor is the best person to help you decide what is right for you and your baby.
What if I have already taken gabapentin during pregnancy?
If you have taken or are taking any medicines it is always a good idea to let your doctor know that you are pregnant so that you can decide together whether you still need the medicines that you are on and, if so, to make sure that you are taking the lowest dose that works and only for as long as you need to.
If you have epilepsy it is very important that you do not suddenly stop taking gabapentin as this could be dangerous to you, and also to your baby if you are already pregnant. Do not make any changes to your medication without first talking to your doctor.
Because of the normal bodily changes that occur as pregnancy progresses your doctor may advise closer monitoring of your health to assess whether your gabapentin dose needs to be adjusted during your pregnancy for it to remain effective. You should not change the dose of any prescribed medicine without medical supervision.
Can taking gabapentin in pregnancy cause birth defects in the baby?
A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.
Around 450 babies born to women who took gabapentin during pregnancy have been studied in total. These babies do not appear to be any more likely to have a birth defect than babies born to women who didn’t take gabapentin, and no link with any particular birth defect has been shown. However, more information needs to be collected from women taking gabapentin during pregnancy to confirm this result.
Gabapentin in combination with other anti-epileptic medicines
Gabapentin is sometimes taken in combination with other medicines to treat epilepsy. Some studies have suggested that women taking combinations of anti-epileptic medicines may be more likely to have a baby with a birth defect than women taking a single anti-epileptic medicine. However, it is now thought that this finding may be due to the fact that many of the women in these studies were taking combinations of anti-epileptics that included sodium valproate (Epilim®), an anticonvulsant medicine which is known to cause birth defects.
We do not know whether gabapentin, when taken in combination with other anti-epileptics in pregnancy, increases the chance of birth defects in the baby. More information on women who are taking gabapentin on its own or in combination with other anti-epileptic medicines needs to be collected.
If you are taking more than one medicine to control epilepsy you should discuss any concerns that you may have with your doctor. Do not stop or alter the dose of any medicine you are taking without first speaking to your doctor. Making changes to your medicine yourself may be more harmful to both you and your baby than continuing to take that medicine.
Can taking gabapentin in pregnancy cause miscarriage?
No link between gabapentin use in pregnancy and miscarriage was shown in any of the three studies that have investigated this. However, because miscarriage risk has been studied in less than 300 pregnant women taking gabapentin so far, more research on this subject is required.
Can taking gabapentin in pregnancy cause stillbirth, preterm birth, or my baby to be small at birth (low birth weight)?
No link between taking gabapentin in pregnancy and an increased risk of stillbirth was identified in one study of 223 women.
The same study did show possible links between taking gabapentin in pregnancy and preterm birth (before 37 weeks of pregnancy), and low birth weight (<2500g). However, there was no link with babies being smaller than expected for the stage of pregnancy at which they were born, suggesting that more babies in this study were small because of being born early and not because gabapentin affects the way that the baby grows in the womb.
Because these results are from just one study more research is required to confirm these findings.
Can taking gabapentin in pregnancy cause other health problems in the child?
Withdrawal symptoms at birth (neonatal withdrawal)
Withdrawal symptoms are thought to occur when a newborn baby’s body has to adapt to no longer getting certain types of medicines through the placenta.
Gabapentin works in a similar way to other medicines that are known to cause neonatal withdrawal. Although one small study did not show that neonatal withdrawal was common in babies exposed to gabapentin in the womb, close monitoring of your baby for a few days after birth may still be advised if you have taken gabapentin regularly in the weeks before delivery. Monitoring of your baby may be particularly important if you have taken gabapentin in combination with other anti-epileptic medicines or medicines that act on the brain.
Learning and behavioural problems
A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour.
There is no known link between taking gabapentin in pregnancy and learning or behavioural problems (such as ADHD or autism spectrum disorder) in the child later on in life. There are, however, no scientific studies that have specifically investigated a link with these problems.
Will my baby need extra monitoring?
Most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects as part of their routine antenatal care. Taking gabapentin in pregnancy is not expected to cause problems that would require extra monitoring of your baby. However, women with epilepsy may be more closely monitored during pregnancy to ensure that they remain well throughout and that their baby is growing and developing as expected.
If you have taken gabapentin around the time of delivery your baby may require extra monitoring after birth because of the risk of neonatal withdrawal.
Are there any risks to my baby if the father has taken gabapentin?
We would not expect any increased risk to your baby if the father took gabapentin before or around the time you became pregnant.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.
Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks. They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.
Medicines use in pregnancy
Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby. There are, however, some medicines that can harm a baby’s normal development. How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.
If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.
When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.
Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.