Table 1.

Anti-epileptic drugs (AEDs) in pregnancy

DrugPharmacokinetic considerations in pregnancyTeratogenic effects
Sodium valproateHigh 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
PhenytoinHighly protein-bound; dose increases rarely requiredIncreased risk of congenital heart defectsAlternative drugs should be used where possible
LamotrigineCarbamazepine, levetiracetamDose may need to be increased two- to threefoldDrug levels and dose adjustment recommended only if there is a change in seizure frequencyAssociated 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