1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-6-90-a 10.15844/pedneurbriefs-6-12-2 Malformations Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Teratogenicity of Anticonvulsants (AEDs) http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 12 1992 01 07 2016 6 12 90 90 Copyright: © 1992 The Author(s) 1992 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pregnancy and the risk of teratogenicity

The risks of teratogenic effects of AEDs are reported from Erasmus University, Rotterdam, The Netherlands.

 Valproate Polytherapy Folic Acid

The risks of teratogenic effects of AEDs are reported from Erasmus University, Rotterdam, The Netherlands. These consist of major malformations, minor anomalies, intrauterine or postnatal growth failure, and psychomotor retardation. The absolute risk of 7-10% is about 3-5% higher than that in the general population. None of the currently available AEDs is free of possible adverse effects on the fetus. Valproate and carbamazepine are associated predominately with spina bifida and hypospadias. Barbiturates and phenytoin are associated with congenital heart malformations and facial clefts. Risk factors include a high daily AED dosage, high maternal serum AED levels, low folate levels, or polytherapy. Genetic predisposition plays a role but no tests are available for identifying parents or fetuses at high risk. Prenatal diagnosis consists of fetal ultrasound during week 18-20, a-fetoprotein analysis of amniotic fluid in week 16 in mothers receiving VPA or CBZ. [1]

COMMENT. Prevention of teratogenetic AED side effects should include the evaluation of the patient before conception, the need for AED therapy, monotherapy with the lowest possible dosage, avoidance of high peak levels by dividing daily dosage into 2 or 3 doses, folic acid supplement in cases of obvious deficiency and exclusion of vitamin B12 deficiency. Minor anomalies tend to lessen or disappear with age (e.g. nail hypoplasia). Pregnancy and teratogenesis in epilepsy was the subject of a Neurology supplement 5, April 1992. The effects of prenatal exposure to anticonvulsants on intellectual functioning of 4-8 year olds are reported by Vanoverloop D et al. from the Department of Pediatrics, Harvard Medical School, Boston [2]. None of the children was mentally retarded, but scores for performance IQ and full scale IQ were lowered.

 Lindhout D Omtzigt JGC Pregnancy and the risk of teratogenicity Epilepsia 1992 33 Suppl 4 S41 S48 10.1111/j.1528-1157.1992.tb06226.x 1425493 Vanoverloop D Schnell RR Harvey EA Holmes LB The effects of prenatal exposure to phenytoin and other anticonvulsants on intellectual function at 4 to 8 years of age Neurotoxicol Teratol 1992 Sep-Oct 14 5 329 335 10.1016/0892-0362(92)90039-D 1454041