Anti-epileptic drug therapy: an overview of foetal effects

Anti-epileptic drugs are associated with several foetal effects which necessitate a rational use of these drugs and early identification of the various adverse manifestations. This article gives a comprehensive review of foetal adverse effects described with various anti-epileptic drugs. The risk of malformations is increased 2-3 folds compared to general population, especially sodium valproate, more with polytherapy. The various manifestations of foetal anticonvulsant syndrome include developmental delay, malformations like facial clefts and neural tube defects, ocular abnormalities, learning difficulties, and digital hypoplasia. There is less data on effects of new anticonvulsant drugs, but they appear to be safer. The risk of teratogenicity is high with traditional drugs and with polytherapy; the newer agents like lamotrigine and oxcarbazepine are relatively safe. Individualisation of the drug therapy, optimisation of the dose and concurrent folic acid administration are important measures to reduce the potential risk to the foetus.