What can we say to women of reproductive age with epilepsy?

Abstract

It is not yet established which antiepileptic drugs (AEDs) are most likely to allow an uncomplicated pregnancy and delivery of a baby who develops normally. Two recent studies of the risk of major malformations, a national birth registry1 and a prospective single experience,2 consisted mainly of carbamazepine (CBZ) or valproate (VPA) exposed pregnancies. Both suggested that first semester exposure to VPA monotherapy carried a higher risk of fetal malformation than exposure to CBZ monotherapy. There is an increased risk3 for abnormalities in infants exposed in utero to phenobarbital, a drug that not long ago was the recommended drug for pregnant women with epilepsy (WWE). In this and a future issue of Neurology , three birth registries are reported. Cunnington et al.4 report results from the lamotrigine (LTG) registry and Wyszynski et al.5 report results from VPA-exposed pregnancies. Both reports track major birth defects evident by ultrasound or inspection within the first few days of life. Artama et al.6 report on the rate of malformations in offspring of WWE after exposure to several AEDs in monotherapy and polytherapy compared to offspring of untreated WWE. Cunnington et al.4 report a 2.9% incidence of major defects in the infants of 414 WWE treated with LTG monotherapy. When LTG was used in polytherapy, there was a 12.5% incidence if it was used with VPA (88 exposures) and a 2.5% incidence with other AEDs (182 exposures). This multinational registry (12 years of observations) enrolled patients voluntarily by physician report, with postpartum physician information. Wyszynski et al.5 report results …