In utero antiepileptic drug exposure

Until recently, retrospective reports and small prospective studies have suggested that all antiepileptic drugs could be associated with teratogenicity. Over the last year alone, several important reports have been released from North America, Australia and the UK. The recently released Neurodevelopmental Effects of Antiepileptic Drugs study combining cohorts from the USA and the UK enrolled women from 1999-2004 and extended these results to include not only risks for major malformations, but also cognitive problems independent of anatomical consequences. In addition, future plans to describe the postnatal manifestations during the first 6 years of life may shed some light on later effects, not previously identified. Information from worldwide pregnancy registries are now reporting results that are alarmingly similar with respect to the increased risk of pregnancies born to women with epilepsy, consistently demonstrating greater degrees of major congenital malformations with the use of valproate, polytherapy and high-dose antiepileptic drugs administered within the first trimester of pregnancy.