If you discover you are pregnant while taking pregabalin, the first thing you need to know about pregabalin and pregnancy is that current evidence doesn’t confirm it causes birth defects, but doesn’t prove it is completely safe either. Some studies noted a slight increase in the likelihood of birth defects, and other large studies found no clear increase. That is why pregabalin is only used during pregnancy if the doctor judges that its benefit is greater than its risk. The most important rule: don’t stop it suddenly on your own, but contact your doctor within days to review the plan.
Pregabalin and pregnancy: does it cause birth defects?
The honest answer: the risk, if there is one, appears small, and the picture isn’t complete yet. Pregabalin crosses the placenta and reaches the fetus, which alone is reason enough for caution. One or more studies pointed to a limited increase in major malformations with exposure in the first months, while later studies including larger numbers of pregnant women came with relatively reassuring results. Health bodies such as the British health service describe the matter as “some studies, but not all” showing a slight increase.
In practice this means most pregnant women exposed to pregabalin give birth to healthy children, but the doctor has no guarantee to offer you, so they weigh your need for the medicine against this possibility.
Why do study results differ?
It isn’t ethically possible to run drug trials on pregnant women, so information relies on following women who took the medicine for their own reasons. These women differ from others in many ways: some have epilepsy or diabetes, some take other medicines, and some smoke or use substances. All these factors may affect the fetus on their own, so it is hard to separate pregabalin’s effect from them. That is why the results are read with caution, and the medicine is treated as “not established as safe” rather than “established as harmful”.
You discovered you are pregnant while taking it: what should you do?
Many pregnancies are discovered weeks after they begin, meaning after the fetus has already been exposed to the medicine. This doesn’t call for panic, but for calm steps:
- Don’t stop suddenly: stopping suddenly may cause unpleasant withdrawal symptoms, and may bring back seizures for those taking it for that reason.
- Contact the doctor who prescribed it: and tell your obstetrician too, so they agree on a single plan.
- Ask about folic acid: the doctor may recommend a higher dose than usual for some pregnant women taking epilepsy and nerve medicines, and they set it.
- Keep up pregnancy follow-up and scans: detailed mid-pregnancy checks reassure the family and detect any problem early.
- Mention everything you take: including painkillers, sedatives and any other substance, without embarrassment.
Women with epilepsy: a special case
For a woman who uses pregabalin as part of epilepsy treatment, the risk of uncontrolled seizures during pregnancy may be greater than the risk of the medicine itself, as a strong seizure may cause the mother to fall and be injured, and may affect the fetus. That is why the decision here isn’t “stop the medicine”, but reviewing the whole plan with the neurologist: is the medicine necessary? Is there an alternative better suited to pregnancy? What is the smallest amount that achieves control?
Planning a pregnancy during treatment
The best situation is for pregnancy to be discussed before it happens. If you are thinking of having children and take pregabalin for nerve pain or anxiety, tell your doctor early, as they may see the possibility of reducing it gradually, replacing it or keeping it at the lowest possible level. Pregabalin doesn’t weaken hormonal contraception, so there is no need to worry on that front, unless it causes vomiting or severe diarrhea that prevents the pills being absorbed.
The last months and delivery: what about the newborn?
If use continues to the end of pregnancy, the newborn may need monitoring in their first days, because medicines that affect the nervous system may cause sleepiness, weak feeding or temporary irritability in them. This is more likely if the mother takes opioids or other sedatives with it. So tell the delivery team in advance, so the pediatrician is prepared and follows the baby carefully.
Pregabalin and breastfeeding
Pregabalin passes into breast milk in small amounts, and reliable health sources indicate that breastfeeding is usually possible with follow-up. What you watch for in the baby: excess sleepiness, weak feeding, or poor weight gain. If you notice any of these, see the pediatrician. More caution is needed with premature or ill babies.
When use is misuse, not treatment
Some pregnant women taking pregabalin aren’t taking it on prescription, but started it for mood or sleep, or in mixtures with tramadol or hashish, and then pregnancy came. Here the risks multiply: uncontrolled amounts, other substances of unknown effect on the fetus, disturbed nutrition and sleep, and missed pregnancy follow-up out of fear of stigma. If this is your situation, pregnancy isn’t a reason to hide the problem, but the strongest reason to ask for help. If you don’t know whether your use has turned into addiction, see pregabalin addiction symptoms.
Can pregabalin be withdrawn during pregnancy?
Yes, but not in the way many imagine. Stopping suddenly in a pregnant woman dependent on the medicine may cause insomnia, severe anxiety, sweating and nausea, and these stresses aren’t in the pregnancy’s interest. It is safest for withdrawal to be gradual, under the supervision of a psychiatrist working with the obstetrician, and for the reasons for use themselves, such as anxiety or pain, to be treated. The details of the expected symptoms are in our article on pregabalin withdrawal symptoms.
Does pregabalin affect male fertility?
Husbands also ask: does the father taking pregabalin harm the pregnancy? Some animal studies showed an effect on fertility, while human data are limited and don’t point to clear harm. If there is a delay in conceiving, it is more useful to mention the medicine to the doctor as part of the assessment than to stop it on your own.
Alternatives the doctor discusses for nerve pain and anxiety in pregnancy
Often the real question isn’t about pregabalin itself, but about the problem it was prescribed for. If the cause is nerve pain, the doctor may suggest physiotherapy, adjusting sleeping and sitting positions, or painkillers with a longer safety record in pregnancy.
If the cause is anxiety, cognitive behavioral therapy is one of the safest and most effective options, and may be enough on its own in mild and moderate cases; if the condition needs medicine, there are anxiety medicines that have been studied in pregnancy more than pregabalin. What matters is that the wish to protect the fetus doesn’t turn into leaving anxiety or pain untreated, as both affect sleep, nutrition and pregnancy follow-up.
There are signs that call for seeing the doctor quickly without waiting for the appointment: sudden swelling of the face or lips, difficulty breathing, severe sleepiness out of proportion to the usual amount, or sad, dark thoughts that weren’t there before.
Questions to ask your doctor
- Do I really need pregabalin during pregnancy?
- Is there an alternative with clearer safety information?
- How do I reduce the amount if we decide to stop, and over how many weeks?
- Do I need folic acid at a different dose?
- Which tests mustn’t I miss?
- Does my baby need special monitoring after birth or during breastfeeding?
How can Riviera Life help you?
If pregabalin has gone beyond the limits of the prescription, Riviera Life’s team of consultants in psychiatry and addiction treatment sets a withdrawal plan that takes account of the pregnancy, coordinating with the obstetrician, in complete confidentiality. For a free consultation call +201507999722, and read the steps of pregabalin addiction treatment.
More from our pregabalin guide
- Pregabalin: the complete guide
- The side effects and serious effects of pregabalin
- Pregabalin and anxiety
- Pregabalin and gabapentin: the difference and which suits you
- Drugs and pregnancy: how each substance affects the fetus and how to get safe help
Questions many people ask
It is only used if the doctor judges that its benefit outweighs its risk, because its safety in pregnancy isn't established, and the decision is made case by case.
Don't stop suddenly; contact your doctor quickly so they can decide whether to continue, reduce gradually or switch, and follow the pregnancy with the right tests.
There is no strong evidence linking it to miscarriage, but data on pregnancy in general are limited, so any use needs follow-up with the obstetrician.
It passes into milk in small amounts, and breastfeeding is usually possible while watching the baby for excess sleepiness or weak feeding and consulting the pediatrician.
It doesn't weaken hormonal contraception, unless it causes vomiting or severe diarrhea that prevents the pills being absorbed.
