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In our study, only 28% of the women continued taking gabapentin throughout pregnancy as two-thirds of the women (66%) discontinued in the first trimester, most following pregnancy confirmation between 6 and 8 weeks’ gestation. Despite the fact that gabapentin (Neurontin) is now used in a wide variety of clinical settings -- for epilepsy, pain management, anxiety, sleep disturbance – there is relatively little information regarding its reproductive safety. A prospective study from researchers at the Motherisk program reports on the outcomes of 223 pregnancies exposed to gabapentin and 223 unexposed pregnancies. Gabapentin use in pregnancy is not very well-studied. While the available information does not strongly suggest that it causes problems for the baby, further research is required to prove that gabapentin is safe. Pregnancy-related problems, such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth) have been reported in some studies looking at the use of gabapentin during pregnancy. To provide evidence on the safety of gabapentin use in pregnancy, we conducted a large cohort study of pregnant women within the US Medicaid Analytic eXtract (MAX) and assessed a range of neonatal and maternal outcomes. When treating neuropathic pain in a woman who is pregnant, the use of gabapentinoids (e.g. gabapentin) or an antiepileptic drug (AED) (e.g. levetiracetam, lamotrigine) is a last line option. This is due to the limited availability of data for safe use during pregnancy. Other options should be trialled first. The objective of this study was to assess the safety of gabapentin (Neurontin) exposure in human pregnancy. Prospective and retrospective data concerning 51 fetuses, including 3 twin gestations, were collected from 39 women with epilepsy and other disorders exposed to gabapentin during pregnancy. Acetaminophen is considered the drug of choice for mild pain during pregnancy. NSAIDS can be used during the first and second trimester, but there are differences between agents in terms of risk category. Ibuprofen, diclofenac, ketorolac and celecoxib can be considered safer options in cases NSAIDS are indicated. Gabapentin/first trimester of pregnancy: 10 newborns (0.01%) [30] Patorno et al., 2020: Gabapentin/first trimester of pregnancy: 4642 pregnancies (0.26%) Patorno et al., 2020: Gabapentin/early in pregnancy (first 140 days of pregnancy and no gabapentin dispensing from the 141 and 245 days)3745 pregnancies (0.21%) Patorno et al., 2020 There was an increased risk of preterm birth among women exposed to gabapentin either late (RR=1.28 [CI 1.08-1.52], p < 0.01) or both early and late in pregnancy (RR=1.22 [1.09-1.36], p < 0.001). Prenatal exposure to pregabalin is associated with an increased risk of congenital anomalies and long-term neurodevelopmental outcomes while gabapentin exposure was associated with an increased risk of preeclampsia, preterm birth and small-for-gestational age. Our objectives were to 1) determine whether first-trimester use of gabapentin is associated with an increased risk for major malformations; 2) examine rates of spontaneous abortions, therapeutic abortions, stillbirths, mean birth weight and gestational age at delivery; and 3) examine rates of poor neonatal adaptation syndrome following late pregnancy exposure. Exposure to gabapentin in pregnant people was defined as having at least one prescription filled during one of the exposure windows of interest (First trimester, Second trimester, and Third trimester) or a prescription filled before the beginning of the exposure window but with a duration overlapping the exposure window. Does taking gabapentin in pregnancy increase the chance of other pregnancy-related problems? Pregnancy-related problems, such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth) have been reported in some studies looking at the use of gabapentin during pregnancy. Short courses of weaker opioids are generally safe in pregnancy, although neonatal abstinence syndrome must be monitored following third trimester exposure. Limited safety data for pregabalin and gabapentin indicate that these are unlikely to be major teratogens, and tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors Up to 80% of pregnant patients with primary headaches experience spontaneous reduction in frequency by the second trimester. Specific causes unique to pregnancy can trigger a headache. Antiprostaglandins, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), are typically contraindicated throughout pregnancy, and if they are used at all, it should only be in the first and second trimester, as these medications hold the risk of causing premature closure of the ductus arteriosus in the fetus if administrated at We examined the risk of major congenital malformations and cardiac defects associated with gabapentin exposure during the first trimester (T1), and the risk of preeclampsia (PE), preterm birth (PTB), small for gestational age (SGA), and neonatal intensive care unit admission (NICUa) associated with gabapentin exposure early, late, or both early Maternal use of gabapentin, particularly late in pregnancy, was associated with a higher risk of PTB, SGA, and NICUa. In a cohort study of pregnant women included in the US Medicaid Analytic eXtract (MAX) dataset, Elisabetta Patorno and colleagues investigate neonatal and maternal outcomes associated with gabapentin exposure during pregnancy. With maternal doses up to 2.1 g/day, estimated doses for fully breastfed infants are 0.2 to 1.3 mg/kg/day (equivalent to 1.3 to 3.8% of the maternal weight-adjusted dose). An expert panel has deemed this drug is an acceptable choice for refractory restless leg syndrome during lactation.
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