Anti-epileptic drugs (AEDs) in pregnancy
| Drug | Pharmacokinetic considerations in pregnancy | Teratogenic effects |
|---|---|---|
| Sodium valproate | High risk (4.7–13.8%) of major fetal malformations (neural tube defects, congenital heart defects) | |
| High rate (30–40%) of impaired psychomotor development and reduced IQ in the child; risk of childhood autism increased fivefold | ||
| The risks are dose-dependent and increase when valproate is combined with other AEDs | ||
| Phenytoin | Highly protein-bound; dose increases rarely required | Increased risk of congenital heart defectsAlternative drugs should be used where possible |
| LamotrigineCarbamazepine, levetiracetam | Dose may need to be increased two- to threefoldDrug levels and dose adjustment recommended only if there is a change in seizure frequency | Associated with fetal malformations, but risk appears relatively low. If epilepsy is well controlled on these drugs then they should be continued |
| Benzodiazepines (diazepam, lorazepam, clobazam) | Not teratogenic in monotherapy, but in most circumstances used as add-on therapy with another AED |