drugs to avoid or use in terms of their pregnancy category

The optimal AEDs therapy of women with epilepsy who are of childbearing age is unclear because of a lack of conclusive data on the comparative teratogenicity of different antiseizure drugs and no antiepileptic drug has proven safe in pregnancy in terms of teratogenesis. Data on the comparative efficacy of various antiseizure drugs for controlling seizures during pregnancy are also quite limited, and there are no randomized trials in this setting. Treatment must be individualized for all patients.

Women with epilepsy are classified as high risk during pregnancy and as there are no clear data indicating that any drug is without risk in pregnancy therefore, the antiseizure drug regimen should be optimized six months prior to planned conception. 

Choice of antiepileptic drugs in women of childbearing age and  pregnant women with epilepsy: 

1. The antiseizure drug that stops seizures in a given patient is the one that should be used with an exception of valproate.

2.  Valproate has a higher teratogenicity and adverse neurodevelopmental outcomes than with other antiseizure drugs, therefore, should be avoided. Current evidence suggests that women taking valproate in the first trimester run the highest risk for congenital malformations.

3. The use of AEDs polytherapy should be avoided, if possible, especially combinations involving valproate, carbamazepine, and phenobarbital.

4. If there is a family history of neural tube defects, both valproate and carbamazepine should be avoided, unless a patient's seizures cannot otherwise be controlled.

Anti-epileptic drugs with their pregnancy category:

Anti-epileptic drugs                     Pregnancy Category 

1. Gabapentin                                           C
2.

Taken from: https://www.medscape.com/viewarticle/702006

Taken from: http://www.pharmaceutical-journal.com/research/review-article/antiepileptic-drug-safety-in-pregnancy-possible-dangers-for-the-pregnant-woman-and-her-foetus/20200320.article