Topiramate exposure in early pregnancy is linked to higher rates of major malformations and more specifically to increased risk of oral clefts, with risk rising at higher doses.
These findings are encouraging and suggest that the newer AEDs, specifically lamotrigine and levetiracetam, are not associated with worse neurodevelopmental outcomes.
Multiple studies have associated first trimester exposure to topiramate with increased risk of oral clefts.
There have long been concerns regarding the safety of the anticonvulsant valproic acid (Depakote) during pregnancy. Â Back in 2009, the American Academy of Neurology and American Epilepsy Society recommended against the use of valproic acid [...]
Pregabalin (marketed in the US as Lyrica) is approved by the US Food and Drug Administration for the treatment of epilepsy, fibromyalgia, and neuropathic pain. Â It is also used off-label to treat psychiatric disorders, most [...]
The European Medicine Agency (EMA)'s Pharmacovigilance and Risk Assessment Committee recently recommended strengthening the restrictions on the use of valproic acid in women of reproductive age. Over the last few years, we have seen a host of articles documenting the deleterious effects of valproic acid on the developing fetus:
A recent study examined the prevalence and risk factors for perinatal depression and anxiety in a group of Norwegian women with epilepsy (n = 706) compared to pregnancies in all women without epilepsy (n = 106,511).
Because breastfeeding has many psychological and medical benefits for both the mother and her child, many women would like to breastfeed. However, all medications taken by the mother are secreted into the breast milk. While various studies have addressed the short-term safety of antiepileptic drugs (AEDs) in nursing infants, none have systematically assessed the long-term effects of exposure to these drugs on cognitive development.
There have long been concerns regarding the use of the anticonvulsant valproate (Depakote) during pregnancy. First trimester use of valproate has been associated with a 3-5% risk of neural tube defects, as well as an increased risk of other malformations affecting the heart. In addition, recent reports have indicated that in utero exposure to valproate may also result in lower IQ.
While it is well-established that several of the older anticonvulsants, including valproate (Depakote), carry a significant teratogenic risk, less is known about the reproductive safety of the newer antiepileptic drugs (AEDs). The North American AED Pregnancy Registry was established in 1997 for pregnant women in the United States and Canada at the Massachusetts General Hospital. The purpose of the registry is to obtain and publish information on the frequency of major malformations among infants whose mothers have taken one or more AEDs during pregnancy.
