13. Major Congenital Malformations in Offspring of Women with Epilepsy

  1. Cynthia L. Harden MD Professor of Neurology3,
  2. Sanjeev V. Thomas MD, DM Professor of Neurology4 and
  3. Torbjörn Tomson MD, PhD Professor of Neurology and Epileptology5
  1. Dina Battino1 and
  2. Torbjörn Tomson2

Published Online: 24 JAN 2013

DOI: 10.1002/9781118531037.ch13

Epilepsy in Women

Epilepsy in Women

How to Cite

Battino, D. and Tomson, T. (2013) Major Congenital Malformations in Offspring of Women with Epilepsy, in Epilepsy in Women (eds C. L. Harden, S. V. Thomas and T. Tomson), John Wiley & Sons, Oxford. doi: 10.1002/9781118531037.ch13

Editor Information

  1. 3

    Chief, Division of Epilepsy and Electroencephalography, Hofstra North Shore-LIJ School of Medicine, Cushing Neuroscience Institutes, Brain and Spine Specialists, North Shore-Long Island Jewish Health System, Great Neck, New York, USA

  2. 4

    Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala State, India

  3. 5

    Karolinska Institutet, Stockholm, Sweden

Author Information

  1. 1

    Epilepsy Centre, Department of Neurophysiology and Experimental Epileptology, IRCCS (Istituto di Ricovero a Cura a Carattere Scientifico) Neurological Institute “Carlo Besta” Foundation, Milan, Italy

  2. 2

    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Publication History

  1. Published Online: 24 JAN 2013
  2. Published Print: 11 MAR 2013

ISBN Information

Print ISBN: 9780470672679

Online ISBN: 9781118531037



  • epilepsy;
  • pregnancy;
  • maternal;
  • offspring;
  • congenital malformation


It has long been known that the risk of major congenital malformations is increased among children of mothers with epilepsy. This is mainly due to the teratogenic effects of antiepileptic drugs. Recent large-scale prospective epilepsy and pregnancy registries have indicated that the rate of major congenital malformations may be up to twofold higher than expected with exposure in utero to the presently most frequently used antiepileptic drugs such as carbamazepine or lamotrigine, Higher rates are consistently reported with exposure to valproic acid. The risk of teratogenic effects appears to be dose-dependent and the lowest effective dose should thus be tried before pregnancy regardless of which antiepileptic drug the woman is taking. Major changes such as switches between drugs should be avoided when pregnancy is established.