Pregabalin and gabapentin are two very similar drugs which are widely used in France, particularly as antiepileptics and to treat neuropathic pain. Taking these drugs during pregnancy exposes unborn children to various known and unknown harms, some of them potentially severe.

In the case of in utero exposure to pregabalin during the first trimester of pregnancy, major malformations are about three times more frequent than in unexposed children. A French study of some 1,700 children exposed in utero showed malformations of the aorta and skull. Smaller-scale studies on gabapentin do not rule out an increased risk of major malformations.

Children exposed in utero to pregabalin or gabapentin in the second and third trimesters of pregnancy were found to have a higher incidence of preterm birth, low birth weight, signs of drug toxicity (drowsiness, difficulty sucking, diarrhoea), withdrawal symptoms and admission to a neonatal intensive care unit.

In the long term, mental and behavioural disorders are more frequent after in utero exposure to pregabalin than in unexposed children. The data on gabapentin is too scant to rule out this risk.

In practice, pregabalin and gabapentin should be avoided whenever possible in women who are or could become pregnant. However, when either of these drugs is chosen during pregnancy, it is important to inform the woman of its known risks and uncertainties. If used close to delivery, it is useful to inform the delivery team so that the neonate receives the necessary monitoring.

©Prescrire 1 May 2020

"Pregabalin or gabapentin during pregnancy: take their known dangers and uncertainties into account" Prescrire Int 2020; 29 (215): 127-129. (Pdf, subscribers only).

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