Gabapentin is a prescription anticonvulsant used to prevent partial seizures, alleviate nerve pain (such as postherpetic neuralgia), and manage restless legs syndrome. When considering any medication during pregnancy, understanding its potential effects on both the pregnant individual and the developing fetus is important.
Current Understanding of Gabapentin’s Safety in Pregnancy
Research on gabapentin use during pregnancy often presents limited or conflicting data. Most information comes from observational studies and pregnancy registries, making direct causal links complex.
Every pregnancy carries a background risk of 3% to 5% for birth defects. Large-scale studies indicate gabapentin exposure in early pregnancy does not increase the overall risk of major malformations above this rate. However, some research suggests a slightly elevated risk of cardiac defects (relative risk ~1.40), particularly with multiple prescriptions in the first trimester. This association may be influenced by underlying maternal health conditions.
Beyond birth defects, studies show increased risks for infants exposed to gabapentin in utero. These include preterm birth (relative risks 1.22-1.28), being small for gestational age (relative risks 1.17-1.39), and requiring neonatal intensive care unit (NICU) admission (relative risk ~1.35). These outcomes may partly reflect underlying maternal health conditions like depression or anxiety.
Neonatal withdrawal symptoms are a specific concern. While gabapentin alone isn’t definitively linked to withdrawal, infants may experience symptoms, especially with co-exposure to opioids late in pregnancy. Symptoms include hypertonicity, tremors, poor feeding, jitteriness, unusual eye or muscle movements, and restlessness. The absolute risk of withdrawal is up to 11.4% in neonates co-exposed to gabapentin and opioids.
The U.S. Food and Drug Administration (FDA) previously categorized gabapentin as Pregnancy Category C. It now uses narrative risk summaries, emphasizing that gabapentin should be used during pregnancy only if potential benefits justify potential risks to the fetus. Animal studies show developmental toxicity, including delayed bone ossification and increased embryofetal mortality, at doses similar to or lower than human clinical use.
Recommendations for Pregnant Individuals
If pregnant or considering pregnancy, consult a healthcare provider before changing your gabapentin regimen. Abruptly stopping can lead to serious issues, such as increased seizures if taken for epilepsy, or worsening other underlying conditions.
A healthcare provider can offer personalized guidance, weighing gabapentin’s benefits against fetal risks. This involves shared decision-making, considering your medical history, the condition being treated, and symptom severity.
Your doctor might discuss adjusting dosage or exploring alternative treatments with established safety profiles. For individuals on anticonvulsants, especially those with epilepsy, a higher dose of folic acid (5mg per day) may be recommended, ideally before conception and through the first 12 weeks of pregnancy.
Monitoring and Management During Pregnancy
If gabapentin use continues throughout pregnancy, close monitoring of both the pregnant individual and the developing fetus is important. This may involve additional ultrasounds or other fetal monitoring to assess growth and development.
After birth, newborns exposed to gabapentin in utero may require monitoring for several days for withdrawal or other adverse effects. Symptoms can include respiratory issues, poor feeding, jitteriness, and unusual movements. These effects may necessitate medical attention and, in some cases, NICU admission.
Managing gabapentin use during pregnancy often involves a multidisciplinary team of healthcare professionals, including obstetricians, neurologists, and neonatologists. They collaborate to provide comprehensive care for both the mother and the infant.
Gabapentin passes into breast milk in low amounts. It is generally considered compatible with breastfeeding, but the decision should be made in consultation with a healthcare provider. They may advise monitoring the breastfed infant for any signs of drowsiness or inadequate weight gain.