A 25-year-old woman with generalized seizures is well controlled on valproate and is considering pregnancy. What should be considered regarding her antiseizure medication?

When a woman with a history of generalized seizures is considering pregnancy while being treated with valproate, a significant concern arises regarding the teratogenic effects associated with this medication. Valproate has well-documented risks when used during pregnancy, particularly in increasing the risk of neural tube defects and other congenital malformations.

Switching to lamotrigine is considered a favorable option because it has a better safety profile in pregnancy compared to valproate. Lamotrigine is considered to have a more favorable risk-benefit ratio for women of childbearing age, especially those who are planning to conceive. It is also effective in treating generalized seizures and can be carefully monitored and adjusted during pregnancy to maintain therapeutic levels, as its clearance can increase during gestation.

This approach helps to minimize potential risks to the developing fetus while effectively managing the mother's seizures. Monitoring and adjusting medication during pregnancy are critical, as seizure control is essential for the health of both mother and child.