Antiepileptic Drugs and Congenital Malformations, and Seizure Control during Pregnancy

Heo, Kyoung

Abstract

Epilepsy is one of the most common neurological problems in pregnancy. For the majority of women, pregnancy proceeds without any apparent difficulties but there is growing evidence of an increased risk of major malformations and later cognitive problems in children exposed to antiepileptic drugs in utero. Updated evidence from several prospective pregnancy registries suggests an increased risk of major malformations with valproic acid compared with other antiepileptic drugs, becoming more evident as doses exceed 1,000 mg/day. The effects of polytherapy appear to carry greater risks compared with monotherapy. Limited data exist for the newer AEDs except for lamotrigine. Although most women with epilepsy have no change in seizure frequency, seizures, especially generalized tonic-clonic seizures can produce adverse effects on mother and fetus. Data about the risk associated with seizures in pregnancy are limited. The pregnancy registry will be performed in Korea to assess the relative risk of major congenital malformation from in utero exposure to antiepileptic drug and to analyze seizure control and treatment in pregnant women with epilepsy.