title: Comparative safety of antiepileptic drugs during pregnancy.
abstract: OBJECTIVE
  To assess the safety of the newer antiepileptic drugs (AEDs) during pregnancy.
  
  
  METHODS
  The study population was pregnant women who enrolled in the North American AED Pregnancy Registry between 1997 and 2011. Data on AED use and maternal characteristics were collected through phone interviews at enrollment, at 7 months' gestation, and postpartum. Malformations were confirmed by medical records. The risk of major malformations was calculated among infants exposed to specific AEDs in monotherapy during the first trimester of pregnancy and among an unexposed group. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated with logistic regression.
  
  
  RESULTS
  The risk of major malformations was 9.3% (30 of 323) for valproate, 5.5% (11 of 199) for phenobarbital, 4.2% (15 of 359) for topiramate, 3.0% (31 of 1.033) for carbamazepine, 2.9% (12 of 416) for phenytoin, 2.4% (11 of 450) for levetiracetam, and 2.0% (31 of 1,562) for lamotrigine. Compared with lamotrigine, the RR was 5.1 (95% CI 3.0-8.5) for valproate, 2.9 (1.4-5.8) for phenobarbital, and 2.2 (1.2-4.0) for topiramate. The proportion of women with epilepsy who had seizures during pregnancy ranged from 23% for valproate to 31% for lamotrigine. Valproate was associated with a higher risk of neural tube defects, hypospadias, cardiac defects, and oral clefts and phenobarbital with a higher risk of cardiac defects and oral clefts; 5 infants exposed to topiramate (1.4%) had a cleft lip.
  
  
  CONCLUSIONS
  AEDs such as valproate and phenobarbital were associated with a higher risk of major malformations than newer AEDs such as lamotrigine and levetiracetam. Topiramate was associated with an increased risk of cleft lip compared with that of a reference population.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. shernan@hsph.harvard.edu
authors.forename: S
authors.initials: S
authors.lastname: Hernández-Díaz
authors.forename: C R
authors.initials: CR
authors.lastname: Smith
authors.forename: A
authors.initials: A
authors.lastname: Shen
authors.forename: R
authors.initials: R
authors.lastname: Mittendorf
authors.forename: W A
authors.initials: WA
authors.lastname: Hauser
authors.forename: M
authors.initials: M
authors.lastname: Yerby
authors.forename: L B
authors.initials: LB
authors.lastname: Holmes
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced* / Q000453:epidemiology; D012042:Registries
chemical_list: D000927:Anticonvulsants