The U.S. Food and Drug Administration (FDA) lists Keppra in Pregnancy Category C. This indicates that caution is advised, but the benefits of the medication may outweigh the potential risks. There have not been enough well-controlled studies in women, but studies in animals have shown some harm to the fetus.

Talk to your doctor or another health professional if you are pregnant or plan to become pregnant. We don't yet have enough information to be able to estimate the risk of various types of birth defects that might occur if Keppra is taken during pregnancy. We also don't know enough to compare the risk with Keppra to the risk with other seizure medicines.

The risk of birth defects is generally higher for women who take more than one AED and for women with a family history of birth defects.

Women who are capable of becoming pregnant should take at least 400 mcg (0.4 mg) of folic acid (folate) daily to help prevent a type of birth defect called a neural tube defect. (The best-known of these is spina bifida, in which the spinal cord is not completely enclosed.) Women at high risk, such as those with a history of this kind of defect in a previous pregnancy, should take 4000 mcg (4 mg) daily, beginning before they become pregnant.

About 20% to 35% of women have seizures more often during pregnancy because of changes in hormones or changes in how their seizure medicine is handled by the body. The doctor may recommend checking the level of medication in the blood regularly during pregnancy so that the dosage can be adjusted as needed.

How much Keppra is passed through breast milk is not known for certain, but the way the body uses it suggests that probably a large portion does enter the milk. If you want to breast-feed your baby, check with your doctor about what seizure medicine would be best for you.