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June 2018

Antiepileptic Drugs in Pregnancy—Quick Decisions With Long-term Consequences

Author Affiliations
  • 1Harvard Medical School, Harvard University, Boston, Massachusetts
  • 2Division of Epilepsy, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Neurol. 2018;75(6):652-654. doi:10.1001/jamaneurol.2017.5060

The use of antiepileptic drugs (AED) is common in women of childbearing age. One study1 reported that prenatal AED exposure occurred in 2.19% of all pregnancies in the United States. In the past decade, findings have highlighted that it is no longer sufficient to only consider the association between first-trimester exposure and the risk for structural teratogenicity, because prenatal AED exposure throughout the entire pregnancy can have long-term negative consequences on neurodevelopment. The published studies are limited in scope but have consistently reported that valproate prenatal exposure is associated with lower scores on neuropsychometric batteries during early childhood,2,3 while prenatal exposure to carbamazepine and lamotrigine monotherapies is associated with relatively normal scores. Risks associated with most other AEDs have not been adequately studied, to my knowledge.

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