Teratogenicity of antiepileptic drugs
Top Cited Papers
- 1 April 2019
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Neurology
- Vol. 32 (2), 246-252
- https://doi.org/10.1097/wco.0000000000000659
Abstract
We review data on the comparative teratogenicity of antiepileptic drugs (AEDs), focusing on major congenital malformations (MCMs), intrauterine growth restriction, impaired cognitive development, and behavioral adverse effects following prenatal exposure. Prospective registries and meta-analyses have better defined the risk of MCMs in offspring exposed to individual AEDs at different dose levels. Valproate is the drug with the highest risk, whereas prevalence of MCMs is lowest with lamotrigine, levetiracetam, and oxcarbazepine. For valproate, phenobarbital, phenytoin, carbamazepine, and lamotrigine, the risk of MCMs is dose-dependent. Prenatal exposure to valproate has also been confirmed to cause an increased risk of cognitive impairments and autistic traits. In a population-based study, the risk of AED-induced autistic traits was attenuated by periconceptional folate supplementation. The risk of adverse fetal effects differs in relation to the type of AED and for some AEDs also the daily dose. Although for MCMs the risk is primarily associated with the first trimester of gestation, influences on cognitive and behavioral development could extend throughout pregnancy. Available information now permits a more rational AED selection in women of childbearing potential, and evidence-based counseling on optimization of AED treatment before conception.Keywords
This publication has 40 references indexed in Scilit:
- Fetal antiepileptic drug exposure: Adaptive and emotional/behavioral functioning at age 6yearsEpilepsy & Behavior, 2013
- Dose dependence of fetal malformations associated with valproateNeurology, 2013
- Prenatal Valproate Exposure and Risk of Autism Spectrum Disorders and Childhood AutismJama-Journal Of The American Medical Association, 2013
- Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational studyThe Lancet Neurology, 2013
- Comparative safety of antiepileptic drugs during pregnancyNeurology, 2012
- Fetal Effects of Anticonvulsant PolytherapiesArchives of Neurology, 2011
- Pregnancy registries: Differences, similarities, and possible harmonizationEpilepsia, 2010
- Management issues for women with epilepsy—Focus on pregnancy (an evidence‐based review): II. Teratogenesis and perinatal outcomesEpilepsia, 2009
- Cognitive Function at 3 Years of Age after Fetal Exposure to Antiepileptic DrugsNew England Journal of Medicine, 2009
- Topiramate in pregnancyNeurology, 2008