IN MONEAD, most pregnant women with epilepsy required antiseizure medication dose increases, followed by early postpartum tapering.
Antiseizure Medication Dosing Strategy During Pregnancy
Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) followed pregnant women with epilepsy at 20 U.S. epilepsy centers and captured daily seizure diaries alongside antiseizure medication type and dosing. This analysis focused on dosing patterns from pregnancy through 6 weeks postpartum among 299 participants enrolled before 20 weeks’ gestation (median 14 weeks) who had favorable seizure outcomes.
Across 363 antiseizure medications used during pregnancy, dose increases occurred for 67.8%, typically beginning a median 32 days after enrollment. By delivery, many patients were receiving substantially higher doses than at conception, consistent with pregnancy related pharmacokinetic alterations that can reduce medication exposure if dosing is not adjusted.
Lamotrigine showed the most frequent escalation. Doses were increased in 87.7% of participants taking Lamotrigine, by 100 mg/day (median), reaching 191% of the conception dose (mean) by delivery. Levetiracetam doses were increased in 56.0% of participants, by 500 mg/day (median), reaching 177% of conception dose (mean) by delivery.
Early Postpartum Tapering Began Within Days
After delivery, dose reductions were common and began quickly. Among 357 antiseizure medications tracked postpartum, 47.9% were decreased within 6 weeks, with the first decrease occurring a median 3 days postpartum. For Lamotrigine, 70.5% of participants had postpartum tapers, by 100 mg/day (median), to 116% of conception dose (mean) by 6 weeks. For Levetiracetam, 34.4% underwent tapers, by 500 mg/day (median), to 136% of conception dose (mean) by 6 weeks.
The authors framed these observed adjustments as a pragmatic view of real-world management in a cohort with favorable seizure outcomes. Limitations included limited first trimester data, enrollment from epilepsy centers, and relatively few participants using a broader range of antiseizure medications.
Notably, dose increases in pregnancy were common across the cohort, while postpartum tapers often started within the first week after delivery. The authors suggest these real world patterns may help clinicians anticipate when reassessment is most likely to be needed and plan closer follow up during these transition points.
Reference: Pennell PB et al. Antiseizure Medication Dosing Strategy During Pregnancy and Early Postpartum in Women With Epilepsy in MONEAD. Neurology. 2026;106(2):e214483.
