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Links between epilepsy drugs and birth defects

A joint study by researchers from the Universities of Liverpool and Manchester has found a link between birth defects and certain types of epilepsy medication.


For most women with epilepsy, continuing medication during pregnancy is important for their health. Over the last 25 years, research has shown children exposed to these medications in the womb can be at a higher risk of having a malformation or birth defect.

Published in the Cochrane Database of Systematic Reviews, the study aimed to expose those antiepileptic drugs (AEDs) given during pregnancy at higher risk of affecting a child with a malformation.


The majority of women with epilepsy must continue antiepileptic drug treatment during a pregnancy.


As part of this systematic review 50 published studies were analysed.

It was found that exposure in the womb to:
  • AED sodium valproate was associated with a 10.93% chance of the child having a significant birth defect which rose as the dose of the drug increased.
  • The types of birth defect that were increased were skeletal and limb defects, cardiac defects, craniofacial defects and neural tube defects.
Children exposed to carbamazepine, topiramate or phenytoin had increased risk of :
  • Significant birth defect but the exact types of defects were not clear
  • Children exposed to phenobarbital were found to be at an increased risk of cardiac defects.
Children exposed to lamotrigine or levetiracetam were not found to be:
  • At increased risk of significant birth defects in comparison to control children
  • And had lower risks when compared to children exposed to carbamazepine, phenytoin or topiramate.

"This important review informs complex discussions during consultations about epilepsy treatment choices for women of childbearing potential, who represent around a third of people with epilepsy worldwide.

"Based on current evidence, levetiracetam and lamotrigine appear to be the AEDs associated with the lowest level of risk, but more data are needed, particularly concerning individual types of malformation."

Tony Marson PhD, Professor of Neurology, University of Liverpool, Institute of Translational Medicine.


Abstract
Background
There is evidence that certain antiepileptic drugs (AEDs) are teratogenic and are associated with an increased risk of congenital malformation. The majority of women with epilepsy continue taking AEDs throughout pregnancy; therefore it is important that comprehensive information on the potential risks associated with AED treatment is available.

Objectives
To assess the effects of prenatal exposure to AEDs on the prevalence of congenital malformations in the child.

Data collection and analysis
Three authors independently selected studies for inclusion. Five authors completed data extraction and risk of bias assessments. The primary outcome was the presence of a major congenital malformation. Secondary outcomes included specific types of major congenital malformations. Where meta-analysis was not possible, we reviewed included studies narratively.

The full study, entitled 'Monotherapy treatment of epilepsy in pregnancy:
congenital malformation outcomes in the child (Review)', can be found here: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010236.pub2/abstract;
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Dec 8, 2016   Fetal Timeline   Maternal Timeline   News   News Archive   



Previous studies have demonstrated a significant increase in risk of birth defects with certain
antiepileptic drugs. Therefore, treatment decisions should be made carefully in collaboration
with an obstetrician to balance maternal health and minimise fetal risk.

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