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Published on: May 16, 2019
Use of antiepileptic medications in pregnancy in relation to risks of birth defects
Martha M Werler1, Katherine A Ahrens, Jaclyn L F Bosco
1Slone Epidemiology Center at Boston University, Boston, MA, USA. werler@bu.edu
Insights
Valproic acid and carbamazapine use during pregnancy are linked to increased risks of major birth defects, including neural tube defects. Further research is needed to find safer antiepileptic drugs for expectant mothers.
Area of Science:
- Obstetrics and Gynecology
- Teratology
- Pharmacovigilance
Background:
- Antiepileptic drugs (AEDs) are commonly prescribed for epilepsy management.
- Understanding the risks of specific AEDs during pregnancy is crucial for maternal and fetal health.
- Current guidelines recommend avoiding certain AEDs due to potential teratogenic effects.
Purpose of the Study:
- To evaluate the association between specific antiepileptic drugs (AEDs) and the risk of major birth defects in infants.
- To assess drug-specific risks, considering timing of exposure and indication for use.
Main Methods:
- Utilized data from the National Birth Defects Prevention Study.
- Assessed the use of various AEDs and their correlation with neural tube defects (NTDs), oral clefts (OCs), heart defects (HDs), and hypospadias.
- Controlled for factors such as timing of AED use and folic acid supplementation.
Main Results:
- Valproic acid use was significantly associated with an increased risk of NTDs, OCs, and potentially HDs and hypospadias.
- Carbamazapine use was linked to a higher risk of NTDs, even when accounting for folic acid intake.
- Epilepsy history alone, without AED use, did not appear to increase the risk of birth defects.
Conclusions:
- Valproic acid demonstrates a strong association with multiple birth defects and should be avoided in pregnancy as per current recommendations.
- Carbamazapine is associated with an increased risk of NTDs, highlighting the need for careful consideration.
- Further research is necessary to identify and validate safer AED alternatives for pregnant women with epilepsy.
Purpose:
To evaluate use of specific antiepileptic drugs (AEDs) in pregnancy in relation to specific birth defects.
Methods:
Using data from the National Birth Defects Prevention Study, we assessed use of AEDs and the risk of neural tube defects (NTDs), oral clefts (OCs), heart defects (HDs), hypospadias, and other major birth defects, taking specific agent, timing, and indication into consideration.
Results:
Drug-specific increased risks were observed for valproic acid in relation to NTDs [adjusted odds ratio (aOR), 9.7;, 95% confidence interval (CI), 3.4-27.5], OCs (aOR, 4.4; 95% CI, 1.6-12.2), HDs (aOR, 2.0; 95% CI, 0.78-5.3), and hypospadias (aOR. 2.4; 95% CI, 0.62-9.0), and for carbamazapine in relation to NTDs (aOR, 5.0; 95% CI, 1.9-12.7). Epilepsy history without AED use did not seem to increase risk.
Conclusions:
Valproic acid, which current guidelines suggest should be avoided in pregnancy, was most notable in terms of strength and breadth of its associations. Carbamazapine was associated with NTDs, even after controlling for folic acid use. Sample sizes were still too small to adequately assess risks of less commonly used AEDs, but our findings support further study to identify lower risk options for pregnant women.
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