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Antiepileptic Drugs and Foetal Malformations: A Possible Class Effect

  • MJ Eadie
  • FJE Vajda

Abstract

About 50 years ago, reports began to appear suggesting that there was an association between taking antiepileptic drugs during pregnancy and the development of foetal malformations. The occurrence of such malformations is relatively uncommon, and it has taken time and the accumulation of moderately sized data collections before the following information has emerged, viz.
  1. (i)

    The tendency of the drugs to be associated with foetal malformation is not a class effect that involves all antiepileptic drugs. Among the more widely used agents is a property of certain drugs, particularly valproate but also to a lesser extent topiramate, probably phenobarbitone and possibly carbamazepine.

     
  2. (ii)

    The risk of foetal malformation associated with valproate is dose dependent.

     
  3. (iii)

    The teratogenesis associated with individual antiepileptic drugs is not limited to the production of one or two particular patterns of malformation but involves an increased risk of many different types of malformation, though there is some evidence that there is a degree of dose specificity between valproate and a particular pattern of malformation, viz. spina bifida.

     
  4. (iv)

    The reported increased hazard of malformations occurring when antiepileptic drugs are combined depends on the presence of a teratogenic substance such as valproate in the combinations, and on its dosage.

     
  5. (v)

    If the use of valproate is not involved and if there is no history of foetal malformation in previous offspring, the hazard of foetal malformation from an antiepileptic drug-exposed pregnancy is not likely to be statistically significantly higher than the risk in pregnancy in the general population.

     

Keywords

Antiepileptic Drug Neural Tube Defect Foetal Malformation Malformation Rate National Birth Defect Prevention Study 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • MJ Eadie
    • 1
  • FJE Vajda
    • 2
  1. 1.Clinical Neurology and NeuropharmacologyUniversity of Queensland, and Honorary Consultant Neurologist, Royal Brisbane and Women’s HospitalBrisbaneAustralia
  2. 2.Department of Medicine and Neurology Director of the Australian Epilepsy and Pregnancy RegisterUniversity of Melbourne and Royal Melbourne HospitalMelbourneAustralia

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