title: 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.
abstract: 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.
authors.affiliation: University of Miami, Miami, Florida, USA.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Harden
authors.forename: Kimford J
authors.initials: KJ
authors.lastname: Meador
authors.forename: Page B
authors.initials: PB
authors.lastname: Pennell
authors.forename: W Allen
authors.initials: WA
authors.lastname: Hauser
authors.forename: Gary S
authors.initials: GS
authors.lastname: Gronseth
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: French
authors.forename: Samuel
authors.initials: S
authors.lastname: Wiebe
authors.forename: David
authors.initials: D
authors.lastname: Thurman
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Koppel
authors.forename: Peter W
authors.initials: PW
authors.lastname: Kaplan
authors.forename: Julian N
authors.initials: JN
authors.lastname: Robinson
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hopp
authors.forename: Tricia Y
authors.initials: TY
authors.lastname: Ting
authors.forename: Barry
authors.initials: B
authors.lastname: Gidal
authors.forename: Collin A
authors.initials: CA
authors.lastname: Hovinga
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Wilner
authors.forename: Blanca
authors.initials: B
authors.lastname: Vazquez
authors.forename: Lewis
authors.initials: L
authors.lastname: Holmes
authors.forename: Allan
authors.initials: A
authors.lastname: Krumholz
authors.forename: Richard
authors.initials: R
authors.lastname: Finnell
authors.forename: Deborah
authors.initials: D
authors.lastname: Hirtz
authors.forename: Claire
authors.initials: C
authors.lastname: Le Guen
mesh_terms: 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
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid