title: Malformation risk of antiepileptic drug exposure during pregnancy in women with epilepsy: Results from a pregnancy registry in South India.
abstract: Kerala Registry of Epilepsy and Pregnancy had been prospectively evaluating the reproductive issues of women with epilepsy since April 1998. This analysis aimed to estimate the relative risk of major congenital malformations (MCM) to the registrants.
  
  
  
  All pregnancies with known outcome in this register until December 2013 were included. Malformation status was evaluated by antenatal ultrasonography, physical examination at birth, echocardiography, and abdomen ultrasonography at 3 months of age and a final review at 1 year of age.
  
  
  
  There were 1,688 fetuses (singlets 1,643, twins 21, and triplet 1) resulting in 1,622 live births. All were born to women of Asian origin living in South India. The MCM rate for all live births was 6.84% (95% confidence interval [CI] 5.71-8.18) and for all pregnancy outcomes including fetal loss was 7.11% (95% CI 5.98-8.44). The MCM rates (mean with 95% CI) for exposed group were 6.4% (5.03-8.03) for monotherapy and 9.9% (7.37-13.13) for polytherapy; internal control group (women with epilepsy [WWE] not on antiepileptic drugs [AEDs] in first trimester) 5.6% (3.34-9.11), external control group (women without epilepsy or AED exposure in first trimester) 3.45% (1.94-6.07). Valproate monotherapy group had a dose-dependent relative risk for MCM of 2.6 (95% CI 1.30-5.20) compared to the external control group. The preliminary data on MCM rate for the nine total clobazam monotherapy (22.2%; 95% CI 6.2-54.7) signals increased risk that needs further validation on larger sample size. There was no association between MCM rate and maternal socioeconomic status, epilepsy syndrome, or use of folic acid in first trimester.
  
  
  
  This dataset from South India confirms the increased risk of MCM with exposure to AEDs, particularly polytherapy. A dose-dependent increased risk was observed with valproate. The increased risk associated with clobazam monotherapy is an important signal that needs to be confirmed in a larger sample.
authors.affiliation: Kerala Registry of Epilepsy and Pregnancy Study Group, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: Sanjeev V
authors.initials: SV
authors.lastname: Thomas
authors.affiliation: Kerala Registry of Epilepsy and Pregnancy Study Group, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: Manna
authors.initials: M
authors.lastname: Jose
authors.affiliation: Kerala Registry of Epilepsy and Pregnancy Study Group, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: Srividya
authors.initials: S
authors.lastname: Divakaran
authors.affiliation: Kerala Registry of Epilepsy and Pregnancy Study Group, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: Prabhakaran
authors.initials: P
authors.lastname: Sankara Sarma
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D005333:Fetus / Q000000981:diagnostic imaging; D006801:Humans; D007194:India / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011264:Pregnancy Trimesters / Q000187:drug effects; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Antiepileptic drug exposure; Indian women; Teratogenic