title: Teratogenicity of Antiepileptic Drugs.
abstract: OBJECTIVE
  Antiepileptic drugs (AED) have chronic teratogenic effects, the most common of which are congenital heart disease, cleft lip/palate, urogenital and neural tube defects. The aim of our study is to examine teratogenic effects of AED and the correlation between these malformations and AED in single or multiple pregnancies.
  
  
  METHODS
  This is a retrospective study of malformations in children born to mothers currently followed up by our outpatient clinics who used or discontinued AED during their pregnancy. Their children were then investigated using echocardiography, urinary ultrasound, cranial magnetic resonance image, and examined by geneticists and pediatric dentists.
  
  
  RESULTS
  One hundred and seventeen children were included in the study. Ninety one of these children were exposed to AED during pregnancy. The most commonly used AED were valproic acid and carbamazepine in monotherapy. The percentage of major anomaly was 6.8% in all children. Dysmorphic features and dental anomalies were observed more in children exposed especially to valproic acid. There were 26 mothers with two and four mothers with three pregnancies from the same fathers. No correlation was found between the distribution of malformations in recurring pregnancies and AED usage.
  
  
  CONCLUSIONS
  Our study has the highest number of dysmorphism examined in literature, found in all the children exposed to valproic acid, which may account for the higher rate of facial dysmorphism and dental anomalies. On lower doses of valproic acid, major malformations are not seen, although the risk increases with polytherapy. Our data also indicate possible effects of genetic and environmental factors on malformations.
authors.affiliation: Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey.
authors.forename: Betül Tekin
authors.initials: BT
authors.lastname: Güveli
authors.affiliation: Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Rasim Özgür
authors.initials: RÖ
authors.lastname: Rosti
authors.affiliation: Department of Pediatric Cardiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Güzeltaş
authors.affiliation: Department of Pedodonty, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.
authors.forename: Elif Bahar
authors.initials: EB
authors.lastname: Tuna
authors.affiliation: Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Ataklı
authors.affiliation: Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Serra
authors.initials: S
authors.lastname: Sencer
authors.affiliation: Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Ensar
authors.initials: E
authors.lastname: Yekeler
authors.affiliation: Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Hülya
authors.initials: H
authors.lastname: Kayserili
authors.affiliation: Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Dirican
authors.affiliation: Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Nerses
authors.initials: N
authors.lastname: Bebek
authors.affiliation: Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Betül
authors.initials: B
authors.lastname: Baykan
authors.affiliation: Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Ayşen
authors.initials: A
authors.lastname: Gökyiğit
authors.affiliation: Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Candan
authors.initials: C
authors.lastname: Gürses
keywords: Antiepileptic drugs; Congenital malformations; Dental anomalies; Dysmorphic features; Teratogenesis