Antiepileptic drugs during pregnancy: What is known and which AEDs seem to be safest?
Article first published online: 5 DEC 2008
Wiley Periodicals, Inc. © 2008 International League Against Epilepsy
Special Issue: Decision Points in Epilepsy: Beside to Bench--Annual Course American Epilepsy Society Annual Meeting, December 4, 2007
Volume 49, Issue Supplement s9, pages 43–55, December 2008
How to Cite
Pennell, P. B. (2008), Antiepileptic drugs during pregnancy: What is known and which AEDs seem to be safest?. Epilepsia, 49: 43–55. doi: 10.1111/j.1528-1167.2008.01926.x
- Issue published online: 5 DEC 2008
- Article first published online: 5 DEC 2008
Most infants born to women with epilepsy are healthy, but there are increased risks related to in utero antiepileptic drug (AED) exposure and seizures. Emerging data from pregnancy registries and other studies allow us to better balance the anatomic teratogenic and neurodevelopmental effects of AEDs against the need to maintain maternal seizure control. Several large prospective pregnancy registries demonstrate a consistent pattern of increased risk for major congenital malformations (MCMs) with valproate (VPA) use as monotherapy, compared to nonexposed populations and to other AEDs used in monotherapy. AED polytherapy likely increases risk for MCMs, but the risk is more pronounced if VPA is included. Reduced cognitive outcomes have been reported with AED polytherapy, and with use of VPA, phenobarbital (PB), and PHT as monotherapy. Dose-dependent risk has been demonstrated with VPA for MCMs and cognitive consequences. CBZ groups show normal neurodevelopment. Increased clearance of most of the AEDs occurs during pregnancy. Use of therapeutic drug monitoring during pregnancy with LTG reduces the risk for seizure worsening. The consistent findings of increased teratogenic risk for VPA should discourage use of this medication as first-line treatment in women of childbearing age.