Can you take gabapentin during pregnancy?

In this article:

• Gabapentin pregnancy
• Risks
• Gabapentin alternatives
• Natural treatments

In this article

• Gabapentin pregnancy
• Risks
• Gabapentin alternatives
• Natural treatments

Gabapentin—sold under the brand names ​​Neurontin, Horizant, and Gralise—is a medication used to treat epilepsy and nerve pain. First discovered in the 1970s, this medication was initially used as a muscle relaxant and to manage spasms. Gabapentin is also prescribed for treating symptoms related to restless leg syndrome, postherpetic neuralgia, and menopause-related hot flashes.

Five in 1,000 pregnant people use antiseizure medications like gabapentin, and the use is increasing. With more frequent use, many wonder: Is gabapentin safe during pregnancy?

Pregnant women are sometimes prescribed gabapentin. However, “as in all cases where a woman has a seizure disorder and requires anti-epileptic therapy, the benefits should outweigh the risks,” explains Kecia Gaither, MD, double board-certified OB-GYN and maternal-fetal medicine specialist at NYC Health + Hospitals/Lincoln in the Bronx, New York.

Can you take gabapentin while pregnant?

“It’s not known if gabapentin is safe for use during pregnancy,” says Ashley Wong, Pharm.D., a member of the SingleCare Medical Review Board. The use of gabapentin by expectant mothers should be a shared decision between a healthcare provider and patient to consider the potential risks of fetal exposure and the benefits of treatment.

The U.S. Food and Drug Administration (FDA) lists gabapentin as a Pregnancy Category C medication. That means while there is no definitive evidence of danger to the fetus, risks cannot be ruled out. Here’s what the existing research shows:

• Animal studies suggest gabapentin could have adverse effects on a fetus.
• A population-based cohort study found no increased risk of neurodevelopmental disorders in babies born to mothers who took gabapentin during pregnancy.
• A population-based cohort study found some evidence of increased risk for cardiac malformation, preterm birth, being small for gestational age, and neonatal intensive care unit admission linked to prenatal gabapentin exposure.
• Studies have yet to be carried out to determine whether gabapentin use alone causes withdrawal effects in neonates. However, one observational study suggested that when used with opioids in late pregnancy, withdrawal symptoms may occur.

What are the risks of taking gabapentin while pregnant?

There is not enough research to definitely say gabapentin is safe to take during pregnancy. 

Before prescribing gabapentin, your healthcare provider may discuss the existing data on pregnancy outcomes.

Some potential risks associated with taking gabapentin while pregnant include:

• Risk of cardiac malformations: Taking gabapentin during the first trimester of pregnancy may potentially cause a moderate increase in the risk of heart malformations.
• Increased risk of preterm birth and small for gestational age (SGA): The use of gabapentin may increase the risk of giving birth before your 37th week of pregnancy, as well as increase the risk of low birth weight or having a neonate smaller in size than expected at that gestational age.
• Increased risk of neonatal intensive care unit admission: Babies exposed to gabapentin in utero, especially during late pregnancy, may be at a higher risk of being admitted into an intensive care unit.
• Potential interaction with nutrients: Gabapentin may interact with certain vitamins and minerals, like folic acid, which is essential for a healthy pregnancy, reducing the levels of these nutrients.

“Tell your provider if you’re pregnant or planning to become pregnant before you start taking the drug,” Dr. Wong advises. If you are already taking gabapentin and find out that you are pregnant, still let your provider know. They can help you determine if you should continue using gabapentin during your pregnancy and suggest a pregnancy registry to report your experience.

If you are planning to breastfeed, Dr. Gaither says gabapentin can be found in breastmilk in breastfeeding mothers taking the medication. However, no side effects have been observed in infants exposed to it.

What can I take instead of gabapentin during pregnancy?

There are alternative medications that can be prescribed for treating neuropathic pain and seizures during pregnancy, such as:

Keppra, Elepsia (levetiracetam)

Levetiracetam is a widely used medication for treating partial seizures in adults, children, and infants one month of age or older. It can also be used in combination with other therapies to treat primary generalized tonic-clonic seizures.

According to studies, this medication appears to be one of the anti-epileptic medications associated with the lowest risk of major congenital disorders compared to other anti-seizure medications like oxcarbazepine, gabapentin, and topiramate.

Lacmital (lamotrigine)

This is an anticonvulsant medication used to treat certain types of seizures in people with epilepsy as well as manage mania and depression in people with bipolar I disorder. Scientific evidence suggests it has a lower risk of causing major congenital malformations compared to some other anti-seizure medications, with one 2022 study supporting its use in pregnancy.

Trileptal (oxcarbazepine)

Oxcarbazepine can be used alone or in combination with other medications to treat seizures in adults and children six years of age and older. Some studies that have assessed the risk of major congenital malformations while on anti-seizure medications found no increased risk associated with fetal exposure to oxcarbazepine.

Elavil, Vanatrip (amitriptyline)

Amitriptyline is an anti-depressant that the FDA has approved for treating depression in adults. It can also be used to treat chronic and nerve pain. There aren’t enough well-controlled studies on its effects on pregnant women. Healthcare providers may prescribe it when its benefits outweigh the potential risks.

If you are pregnant and are on an anti-epileptic medication like gabapentin, it’s important that you don’t stop your medication without speaking with your healthcare provider. “There exists a risk to the mother and the fetus if the medication is discontinued during pregnancy. Sustained seizure activity (status epilepticus) may cause death for both and potential neurodevelopmental issues for the progeny,” Dr. Gaither explains.

Natural remedies for epilepsy and nerve pain during pregnancy

Aside from medications, managing nerve pain and epilepsy may also include home remedies and natural practices like:

• Limiting stress: It is important to reduce stress during pregnancy, especially if you have medical conditions like seizures, which stress can trigger or worsen. Managing stress with approaches like relaxation, mindfulness, and meditation can reduce your risk of seizures.
• Supplementing with vitamins and minerals: Taking a folic acid supplement is essential during pregnancy as it can significantly reduce the risk of serious congenital disabilities, thereby mitigating the risk of anti-convulsant medications. Also, anti-convulsant drugs may affect the absorption of certain vitamins and minerals, such as calcium, vitamin D, and vitamins B6 and B7, leading to deficiencies. Discuss the best prenatal supplement with your obstetrician.
• Dietary changes: Studies have indicated that dietary plans like the ketogenic diet—foods high in fat and low in carbs—may be helpful for managing epilepsy, especially in people who are not appropriately responding to anti-epileptic medications. It’s best to work with your healthcare team to develop a personalized dietary plan best suited for your condition.
• Avoiding triggers: Avoiding the things that trigger your seizures can help prevent or reduce the number of times they occur. Triggers may include stress, dehydration, sleep deprivation, and alcohol consumption.

Studies suggest that practices like yoga, biofeedback—a mind-body technique that helps control certain involuntary body functions—and vagus nerve stimulation may help manage epilepsy symptoms. However, more research is needed to determine their efficacy and safety during pregnancy.

“For pregnant women with a seizure disorder, combined care with a maternal-fetal medicine specialist and a neurologist is highly recommended,” Dr. Gaither notes.