Levetiracetam (Keppra®)

Last Update: 22 May 2025

Medication

Table of content

1. What is it? 2. Levetiracetam during pregnancy 3. Risks 4. Benefits 5. Breastfeeding or chestfeeding 6. Key Takeaways 7. Research limits

Welcome to our Fact Sheet on levetiracetam during pregnancy and breastfeeding or chestfeeding. The information given is based on current research and may be updated with new scientific knowledge. This information does not replace personalized advice from healthcare professionals.

1. What is levetiracetam?

Levetiracetam, also known by its brand name Keppra®, is a type of anti-seizure medications (ASMs). This means it helps prevent seizures in people who have epilepsy. It is also used in some cases to help with mood stability in people with bipolar disorder, and migraines.

If you are pregnant or planning to become pregnant and take levetiracetam, it’s important to know how to manage your treatment safely. You can also consult our factsheet on epilepsy for more information here.

How to have a healthy pregnancy with epilepsy.

Learn more

2. Can I take levetiracetam during pregnancy?

If you’re pregnant and taking levetiracetam for epilepsy, it’s important to keep taking your medication until you can speak with your healthcare provider. Suddenly stopping levetiracetam can cause seizures, which can be dangerous for both you and your baby. For more information, you can also refer to our factsheet on epilepsy. Planning your pregnancy with your healthcare team is strongly recommended. With early planning and regular check-ups, more than 90% of people treated for epilepsy can have healthy pregnancies.

Research show that taking levetiracetam during pregnancy does not increase the risk of serious congenital malformations (birth defects). If you need to start levetiracetam while pregnant, your healthcare provider will carefully consider the advantages and risks of the treatment and medical conditions. They may also adjust your dose during pregnancy to find the safest option for you and your baby. In general, they will aim to use the lowest effective dose of medication, and the fewest number of medications, to reduce any possible risks during pregnancy.

Sometimes, pregnancy changes how the body uses medications. This can make levetiracetam less effective and increase the risk of seizures in people with epilepsy. Thus, in some cases, your healthcare team may check blood levels throughout your pregnancy to better adjust the dose. However, if these testing isn’t possible, your dose may be adjusted based on your symptoms and how your pregnancy is progressing.

You should always talk to your healthcare provider before making any changes to your medication during pregnancy to make sure you and your baby stay safe. It’s also important to let your delivery team know that you are taking levetiracetam and ensure they have access to any care plans or recommendations from your specialist for labor, birth, and any adjustments needed in postpartum.

Note: The Society of Obstetricians and Gynaecologists of Canada recommends taking at least 1 mg of folic acid per day before and during pregnancy if you take levetiracetam. This may help your baby’s brain and development and lower risk of neural tube defects.

3. What are the risks of taking levetiracetam during pregnancy?

As with any medication, it’s important to talk to your healthcare team to understand the benefits and possible risks. This helps make sure that both you and your baby get the best care. Levetiracetam is usually prescribed during pregnancy when the benefits of controlling seizures are greater than the possible risks.

Understanding the risk during pregnancy

Every pregnancy has some natural risk of complications like miscarriages (loss of the baby), premature birth (baby comes before 37 weeks), congenital malformations tooltip, and other complications. These risks can happen in any pregnancy for many reasons, even when no medication is used. This is called the background risk. Research helps us estimate these risks. When thinking about the risks of levetiracetam, we compare them to this background risk.

Based on current research, the risk of congenital malformations with levetiracetam is generally considered about the same as the background risk, especially when it is used alone (monotherapy).

Some studies have shown a slightly higher chance of preterm birth (birth before 37 weeks) in people who take levetiracetam during pregnancy. But it’s not clear if this is caused by the medication itself or by the epilepsy or other health conditions being treated. Again, more research is needed to better understand this.

The table below summarises what research found about the possible risks of taking levetiracetam during pregnancy compared with the background risks.

Table 1. Possible risks associated with levetiracetam during pregnancy.

For who?	What?	What does research say?
Pregnant person	Fertility (ability to get pregnant)	There is not enough research to know if levetiracetam affects fertility. Using seizure medications for a long time may cause irregular periods, which could make it harder to get pregnant.
Pregnant person	Miscarriages	More research is needed.
Unborn baby	Congenital Malformations	Several studies looking at thousands of pregnancies found no increased risk of birth defects compared with the background risk (3 out of 100 pregnancies).
	Growth (small for gestational age)	More research is needed to fully understand this risk.
	Premature Birth	Some studies show a slightly higher chance of premature birth (before 37 weeks). But this may be caused by epilepsy or another health condition, not the medication. More research is needed.
Child later in life	Brain Development	Some studies found no link between levetiracetam and language delay in babies. More research is needed to confirm these risks.
Child later in life	Long-term health	We don’t know yet if levetiracetam affects a child’s health later in life. More research is needed.

4. Aside from the risks, what are the benefits of levetiracetam?

Keeping seizures under control is very important for both you and your baby, because seizures that are not managed can lead to serious problems. These can include injuries, early labor, placental abruption tooltip, or even miscarriage. More information can be found on our factsheet on epilepsy here.

Taking levetiracetam offers several benefits during pregnancy:

Flexibility in dose adjustment: Levetiracetam can be adjusted as pregnancy progresses so your treatment stays effective throughout your pregnancy.
Fewer interactions with other medications: Levetiracetam has fewer interactions with other medications, which is helpful if you need other treatments during pregnancy. It’s also generally well tolerated, meaning most people don’t have serious side effects.
Effective seizure control: Levetiracetam is effective for treating many types of seizures linked to epilepsy, which helps reduce risks to both the parent and the baby.

In summary, levetiracetam can help lower the risk associated with untreated epilepsy. Always talk to your healthcare provider to discuss the benefits and risks that apply to your situation.

5. Will I be able to breastfeed or chestfeed?

Like many other medication, levetiracetam passes into human milk in small amount. These small amounts are not expected to harm your baby.

There is not a lot of research about how levetiracetam affects babies who are breastfed or chestfed. In adults, common side effects include feeling sleepy (somnolence) or dizzy. Because of this, if you are taking levetiracetam while breastfeeding or chestfeeding, it’s important to watch your baby for signs of sleepiness or unusual behavior. There is also no research yet on the effect of levetiracetam on your milk production.

It is a good idea to discuss your situation and your desire to breastfeed/ chestfeed with your healthcare provider during your pregnancy. They can help you weigh the benefits of breastfeeding/ chestfeeding against the possible risks. They can also help create a clear plan for the team who will be welcoming your newborn and decide on the best approach for both your health and your baby’s well-being.

To make the best choice for you and your baby, talk with your doctor, pharmacist, midwife, or lactation consultant. They will help you look at the benefices and any possible risks so you can make an informed decision. If you have any questions related to breastfeeding or chestfeeding, don’t hesitate to speak with your healthcare team.

6. Key Takeaways

Levetiracetam (Keppra®) is an anti-seizure medication that helps prevent in people with epilepsy. Sometimes it is also used for other conditions like bipolar disorder and migraines.
During pregnancy, levetiracetam is usually used at the lowest dose that still works well, when the benefits are greater than the possible risks.
So far, research shows that levetiracetam does not increase the risk of malformations for the baby compared to the background risk. We still need more studies to understand if there is a higher risk for low birth weight, preterm birth, or brain developments.
Levetiracetam passes into human milk in small amount, but it is not expected to harm a breastfed or chestfed baby. If you are taking this medication and want to breastfeed or chestfeed, talk to your doctor or healthcare team to find the best option for you.
With regular check-ups and an open conversation with your healthcare provider you can create a plan, ideally before your pregnancy, to have a healthy pregnancy for you and your baby.

7. Research Is Great, But It Is Not Perfect

Making informed health decisions during pregnancy also means understanding the current state of scientific knowledge. Research on levetiracetam during pregnancy has taught us a lot, but there are still some limits and gaps to be aware of:

Not enough long-term research: Most studies only look at short-term effects. We don’t yet know how taking levetiracetam in pregnancy might affect a child’s growth or development over time.
Studies with small groups: Not many people have epilepsy, and not everyone with epilepsy takes levetiracetam. Because of this, studies often include small numbers of people. This makes it hard to be sure about the safety and efficacy results.
Changes in doses during pregnancy: When someone is pregnant, their body changes how it uses and breaks down levetiracetam. Some studies don’t include this, so we may not know exactly how well the medicine works or how safe it is during pregnancy.
Other factors: Many studies don’t look at things like other medications, other health problems, or personal factors like age, culture, income, or gender identity. These can all affect the results.
Research on breastfeeding or chestfeeding: There is very little research about levetiracetam and human milk. We don’t know if it changes how much milk is made or how it might affect a baby who is fed human milk.

Overall, while levetiracetam is considered as a good option during pregnancy based on available research, these limitations highlight the need for ongoing studies and careful consideration by healthcare providers when prescribing it to pregnant individuals.

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