Risk of fetal death and malformation related to seizure medications

Abstract

There is increasing interest regarding the efficacy and safety of seizure medications in special populations, such as in children, the elderly, and pregnant women. The information regarding the safety of newer medications to the embryo and fetus in pregnant women with epilepsy is still sparse, but there is a renewed effort to evaluate the risks in order to better advise women of child-bearing age. Several pregnancy registries in the United States, Europe, and Australia are collecting data on the risk of major malformations caused by seizure medications. More information about epilepsy can be found on the next page. In this issue of Neurology , a study by Meador et al.,1 titled “In Utero Antiepileptic Drug Exposure: Fetal Death and Malformations,” compares the risk of fetal death and congenital malformations for four commonly used seizure medications, including lamotrigine, carbamazepine, phenytoin, and valproic acid. These data are part of an ongoing study looking at short- and long-term developmental effects of seizure medications in children of mothers with epilepsy. Fetal exposure to seizure medications may lead to fetal death or congenital malformations, affecting the brain and spinal cord, orofacial cavities, heart, kidneys and urinary tracts, genitals, and skeleton. They are reported to occur in about 6% of pregnancies in women with epilepsy, constituting twice the risk compared to the general population. To what extent these abnormalities are related to seizures, the underlying epilepsy or psychosocial factors, or seizure medications is unclear. Nonetheless, most women with epilepsy need to be treated during pregnancy. Epileptic seizures are potentially dangerous to the pregnant woman and the fetus. Isolated seizures can lead to falls or other forms of physical injury, while frequent or prolonged seizures can lead to physical stress endangering the health of …