Maternal Use of Anticonvulsant Drugs and Infant Congenital Malformations
Among anticonvulsant drugs some are well-known teratogens, notably phenytoin, phenobarbitone, primidone, trimethadione, paramethadione, valproic acid, and topiramate. Some much used anticonvulsants like carbamazepine and lamotrigine have a low teratogenic potential and should therefore be preferred, but are probably not completely free of teratogenicity. For many, notably recently introduced, anticonvulsants enough data do not exist to evaluate their risks—until more data are available it is probably well to regard them as potential teratogens.
Polytherapy of anticonvulsants carries a higher risk than monotherapy and should if possible be avoided. The use of anticonvulsant polytherapy during pregnancy has declined markedly in Sweden. When exposure has occurred for valproic acid or carbamazepine, detailed prenatal diagnosis, notably in order to detect spina bifida, is recommended.
Besides gross malformations, anomalies in infant facial and digital appearance have been described after maternal use of various anticonvulsants, often combined with long-term neuropsychiatric effects. For these outcomes, late pregnancy exposures may be most important.
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