Anti-seizure medications (ASM): teratogenicity risks

Evidence-based neurology checklist on anti-seizure medications (asm): teratogenicity risks: Risk profile Valproate: 9.2% Phenobarbitone: 6% Topiramate: 5.1% Pregabalin: 3.2% Phenytoin: 2.8% Carbamazepine: 2.8% Lamotrigine: 2.1% Levetiracetam: 2.0% Oxcarbazepine: 1.5% Gabapentin: 1.5% Zonisamide:…

Risk profile

  • Valproate: 9.2%
  • Phenobarbitone: 6%
  • Topiramate: 5.1%
  • Pregabalin: 3.2%
  • Phenytoin: 2.8%
  • Carbamazepine: 2.8%
  • Lamotrigine: 2.1%
  • Levetiracetam: 2.0%
  • Oxcarbazepine: 1.5%
  • Gabapentin: 1.5%
  • Zonisamide: 1.3%
  • Lacosamide: 0%
  • Polytherapy increases the risk: especially if Valproate or Topiramate are involved

Neural tube defects

Anencephaly

Cardiac and other organ defects

Cleft palate

Foetal death

References

  1. Hernandez-Diaz S, Quinn M, Conant S, et al. Use of antiseizure medications early in pregnancy and the risk of major malformations in the newborn. Neurology 2025; 105:e213786.
  2. Bromley RL, Weston J, Marson AG. Maternal use of antiepileptic agents during pregnancy and major congenital malformations in children. JAMA 2017; 318:1700-1701. 
  3. Vajda FJE, Graham JE, Hitchcock AA, Lander CM, O'Brien TJ, Eadie MJ. Antiepileptic drugs and foetal malformation: analysis of 20 years of data in a pregnancy register. Seizure 2019; 65:6-11.
  4. Verrotti A, Mencaroni E, Castagnino M, Zaccara G. Foetal safety of old and new antiepileptic drugs. Expert Opin Drug Saf 2015; 14:1563-1571.
  5. Brodie MJ, Kwan P. Current position of phenobarbital in epilepsy and its future. Epilepsia 2012; 53(Suppl 8):40-46.
  6. And 12 more. Subscribe to see the full list

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