Anti-seizure medicines in pregnancy
April 2018 to March 2026

About this release

This biannual release by Public Health Scotland reports on anti-seizure medicines (ASMs) dispensed up to 31st March 2026 to patients in Scotland aged 0-54, and specifically in pregnant women. ASMs are used in the management of epilepsy, but also for other conditions such as migraine, bipolar disorder, and some types of pain. The reason for prescribing is not recorded therefore prescribing data is included for all conditions. This summary presents the key messages on prescribing of valproate and topiramate. 

ASM exposures in pregnancy reported here can be the result of prescribing that has taken place in primary care or administration of an ASM in a hospital inpatient setting up to 28 days prior to estimated date of conception. Further information is available on these and other ASMs in the accompanying dashboard.

All definitions can be found in the Cohort Definitions section and Notes pop-ups in the dashboard.

Anyone taking ASMs should speak to their GP or consultant if they have questions about the possible impact of their medicines on a pregnancy.

Main points

Valproate prescribing in pregnancy

• Two pregnancies were exposed to valproate from July 2025 to March 2026. Complete data on all pregnancies in this time period was not available at time of extract.
• One of these was the result of a prescription started during pregnancy (where there were no recorded prescriptions in the previous 12 months). It is possible that in this case, there were previous valproate prescriptions but the prescribing record was not available for our analysis.

Topiramate prescribing in pregnancy

• Six pregnancies were exposed to topiramate from July 2025 to March 2026. Complete data on all pregnancies in this time period was not available at time of extract.
• One of these was the result of a prescription started during pregnancy (where there were no recorded prescriptions in the previous 12 months). It is possible that in this case, there were previous topiramate prescriptions, but the prescribing record was not available for our analysis.

A line chart showing trend in pregnancies exposed to valproate and topiramate from April 2018 to March 2026. This includes numbers of pregnancies and also quarterly average,

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Chart 1: Pregnancies exposed to valproate and topiramate (April 2018 to March 2026)¹

1. Quarterly average is based on the average of the previous four quarters.

2. The shaded area indicates the period after July 2025, where numbers may start to decline as there may be pregnancies that are still ongoing up to 31 March 2026 that had not been exposed up to that point and may become exposed as the pregnancy progresses.

Valproate prescribing  overall in females and males aged 0-54

• 1,866 females were prescribed valproate in the most recent quarter reported (January to March 2026). This has decreased by 56%, from 4,237 in April to June 2018.
• There were 32 female valproate new starts (females prescribed valproate for the first time in 12 months) in January to March 2026. This has decreased by 75% from 128 in April to June 2018.
• 5,097 males were prescribed valproate in the most recent quarter reported (January to March 2026). This has decreased by 29%, from 7,157 since the quarter April to June 2018.
• There were 91 male valproate new starts (males prescribed valproate for the first time in 12 months) in January to March 2026. This has decreased by 62% from 242 in April to June 2018.

Topiramate prescribing overall in females aged 0-54

• 2,915 females were prescribed topiramate in the most recent quarter reported (January to March 2026) This has decreased by 30%, from 4,171 in April to June 2018.
• There were 230 female topiramate new starts (females prescribed topiramate for the first time in 12 months) in January to March 2026. This has decreased by 66% from 669 in April to June 2018.

A line chart showing trend in valproate and topiramate new starts from April 20188 to March 2026.

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Chart 2: Valproate and topiramate new starts (April 2018 to March 2026)

Background

Valproate taken during pregnancy is known to be associated with an increased risk of both congenital and neurodevelopmental conditions. There is also a possible association between use of valproate by men around the time of conception and an increased risk of neurodevelopmental conditions in their children and therefore prescribing rates for valproate in males are included. Topiramate taken during pregnancy is associated with a higher risk of congenital conditions, low birth weight, and a potential increased risk of neurodevelopmental conditions. For full details and prescribing guidance please see Medicines and Healthcare products Regulatory Agency (MHRA) advice for valproate and topiramate, as well as the commentary section of the dashboard. For a more detailed review of the safety of anti-seizure medicines in pregnancy see the January 2021 report published by the Commission on Human Medicines (CHM).

Individuals should not stop taking ASMs without medical advice. Anyone taking ASMs should speak to their GP or consultant if they have questions about the possible impact of their medicines on a pregnancy.

Further information

The next release of this publication will be April 2027.