Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): II. Teratogenesis and perinatal outcomes: Report of the Quality Standards Subcommittee and Therapeutics and Technology Subcommittee of the American Academy of Neurology and the American Epilepsy Society.
A committee assembled by the American Academy of Neurology (AAN) reassessed the evidence related to the care of women with epilepsy (WWE) during pregnancy, including antiepileptic drug (AED) teratogenicity and adverse perinatal outcomes. It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine (CBZ), and possibly compared to phenytoin (PHT) or lamotrigine (LTG). It is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. AED polytherapy probably contributes to the development of MCMs and reduced cognitive outcomes compared to monotherapy. Intrauterine exposure to VPA monotherapy probably reduces cognitive outcomes and monotherapy exposure to PHT or phenobarbital (PB) possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of <7. If possible, avoidance of VPA and AED polytherapy during the first trimester of pregnancy should be considered to decrease the risk of MCMs. If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered and avoidance of PHT and PB throughout pregnancy may be considered to prevent reduced cognitive outcomes.
Harden
Cynthia L
CL
University of Miami, Miami, Florida, USA.
Meador
Kimford J
KJ
Pennell
Page B
PB
Hauser
W Allen
WA
Gronseth
Gary S
GS
French
Jacqueline A
JA
Wiebe
Samuel
S
Thurman
David
D
Koppel
Barbara S
BS
Kaplan
Peter W
PW
Robinson
Julian N
JN
Hopp
Jennifer
J
Ting
Tricia Y
TY
Gidal
Barry
B
Hovinga
Collin A
CA
Wilner
Andrew N
AN
Vazquez
Blanca
B
Holmes
Lewis
L
Krumholz
Allan
A
Finnell
Richard
R
Hirtz
Deborah
D
Le Guen
Claire
C
D000014:Abnormalities, Drug-Induced / Q000209:etiology*; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001724:Birth Weight / Q000187:drug effects; D003072:Cognition Disorders / Q000139:chemically induced*; D000075202:Contraindications; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011297:Prenatal Exposure Delayed Effects; D012306:Risk; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use
D000927:Anticonvulsants; D014635:Valproic Acid