AEDs during pregnancy

Three reports describing the effects of exposure to antiepileptic drugs (AEDs) during pregnancy are published in a recent issue of Neurology. An editorial, published in the same edition, reviews the studies.Wyszynski and colleagues describe the results from the North American Antiepileptic Drug Pregnancy Registry, which showed that 16 (10.7%) cases of congential malformations were identified among the offspring of 149 women exposed to valproic acid during the first trimester of pregnancy. The authors report that the prevalence among offspring of women exposed to all other antiepileptic drugs was 2.9%, and the prevalence in the general population was calculated to be 1.62%.The International Lamotrigine Pregnancy Registry figures, reported in the same issue of Neurology, provide an estimate of the risk of all major birth defects after first-trimester exposure to lamotrigine monotherapy of 2.9%. The authors describe the risk as "similar to that in the general population and in other registries enrolling women exposed to antiepileptic monotherapy (3.3-4.5%)." However, they say that the sample size (n=414) was too small to detect any but very large increases in specific birth defects.The third report is of a retrospective study investigating the long-term effects on cognitive functioning in school-aged children exposed to AEDs in utero. Vinten et al. report that children exposed to sodium valproate had a significantly lower verbal IQ compared to children exposed to other AEDs and to children not exposed to AEDs. The valproic acid-exposed children were also more likely to have memory impairment when compared to the other groups.In an accompanying editorial, What can we say to women of reproductive age with epilepsy?, Drs. Penovich and Gaily review the studies. References...