Guidelines for Babies of Mothers on Anticonvulsants

 

Reviewed by Clinical Practice Committee
May 2016
Clinical Guidelines Back Newborn Services Home Page

Summary

Summary table: Commonest malformations by AED

AED Commonest Malformations Neonatal Side effects
Carbamazepine
  • Cardiac

  • Orofacial clefts

  • NTD

  • Withdrawal symptoms
Phenytoin
  • Cardiac

  • Orofacial clefts

  • Withdrawal symptoms
Valproate
  • Cardiac
  • NTD
  • Facial dysmorphism
  • Hypospadias
  • Poor cognitive outcomes
  • Neonatal hypoglycaemia
  • Withdrawal symptoms
Lamotrigine
  • Cardiac
  • Cleft lip and/or palate
  • Withdrawal symptoms
Topiramate
  • Cleft lip and/or palate
  • Withdrawal symptoms
Gabapentin
Levetiracetam
  • Little data on commonest malformations – lower rates than other
  • Withdrawal symptoms

Management of infants exposed to AED in-utero

(even if exposure only during first or second trimester)

If an infant is identified with a problem secondary to maternal AED

References

1 Tomson T, Battino D. Teratogenic eff ects of antiepileptic drugs. Lancet Neurology. 2012;11:803–13
2 Moussa H, Ontiveros A, Haidar Z, Sibai B. Safety of anticonvulsant agents in pregnancy, Expert Opinion on Drug Safety. 2015;14:1609-1620
3 Tomson T, Xue H, Battion D. Major congenital malformations in children of women with epilepsy. Seizure. 2015;28:46-50
4 Ebbesen F, Joergensen A, Hoseth E, Kaad P, Moeller M, Holsteen V, Rix M. Neonatal hypoglycaemia and withdrawal symptoms after exposure in utero to valproate. Archives of Disease in Childhood Fetal & Neonatal Edition 2000;83(2):F124-F129.
5 Dean J, Hailey H, Moore S, Lloyd D, Turnpenny P, Little J. Long term health and neurodevelopment in children exposed to antiepileptic drugs before birth. Journal of Medical Genetics. 2002;39:251-259
6 Bromley R, Weston J, Adab N, Greenhalgh J, Sanniti A, McKay AJ, Tudur Smith C, Marson AG. Treatment for epilepsy in pregnancy: neurodevelopmental outcomes in the child. Cochrane Database Syst Rev. 2014 Oct 30;10:CD010236. doi: 10.1002/14651858.CD010236.pub2
7 Campbell E, Devenney E, Morrow J, Russell A, Smithson W, Parsons L, Robertson I, Irwin B, Morrison P, Hunt S, Craig J. Recurrence risk of congenital malformations in infants exposed to antiepileptic drugs in utero. Epilepsia. 2013;54:165–171.
8 Hernández-Díaz S, Werler M, Walker A, Mitchell A. Folic acid antagonists during pregnancy and the risk of birth defects. NEJM. 2000;343(22):1608-14.