Reproductive health effects and teratogenicity of antiepileptic drugs.
Women with epilepsy are less likely to bear children than women in the general population, and although this reduced fertility can be attributed in part to effects of the disease itself, the effects of antiepileptic drugs (AEDs), including changes in reproductive endocrine function, are also a factor. Conversely, some AEDs interact with oral contraceptives and can increase the risk for contraceptive failure and unplanned pregnancy. Women with epilepsy also have elevated rates of congenital anomalies and major malformations in their offspring, for which exposure of the developing fetus to AEDs taken by the mother appears to be responsible. In utero exposure to some AEDs may also be associated with increased risk for impaired cognitive function in the growing child. Clearly, possible long-term effects on reproductive health and pregnancy outcomes require careful attention when AED therapy is being considered for a patient with childbearing potential. Moreover, because AEDs are increasingly being used in therapy for other conditions such as migraine, bipolar disorder, and pain, it is not only the treatment of women with epilepsy that will be affected by these concerns.
Kaplan
Peter W
PW
Department of Neurology, Johns Hopkins Bayview Medical Center, B. Bldg., 1 North, Rm. 125, 4940 Eastern Avenue, Baltimore, MD 21224, USA. pkaplan@jhmi.edu
D000014:Abnormalities, Drug-Induced / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy; D003278:Contraceptives, Oral, Hormonal / Q000493:pharmacokinetics; D004347:Drug Interactions; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy; D007172:Erectile Dysfunction / Q000139:chemically induced; D005260:Female; D018756:GABA Antagonists / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D012739:Gonadal Steroid Hormones / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D007247:Infertility, Female / Q000139:chemically induced / Q000209:etiology; D008607:Intellectual Disability / Q000139:chemically induced; D008297:Male; D008599:Menstruation Disturbances / Q000139:chemically induced; D008862:Microsomes, Liver / Q000201:enzymology; D008881:Migraine Disorders / Q000150:complications / Q000188:drug therapy; D010053:Ovary / Q000187:drug effects; D010146:Pain / Q000150:complications / Q000188:drug therapy; D011085:Polycystic Ovary Syndrome / Q000139:chemically induced; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011256:Pregnancy Outcome; D011297:Prenatal Exposure Delayed Effects; D012098:Reproduction / Q000187:drug effects*
D000927:Anticonvulsants; D003278:Contraceptives, Oral, Hormonal; D018756:GABA Antagonists; D012739:Gonadal Steroid Hormones