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Women with epilepsy (WWE) considering childbearing are usually advised to remain on antiepileptic drugs (AED) during pregnancy and throughout their reproductive years. Balancing the risk of seizures with the risk of AED exposure to the developing fetus has been actively investigated.1,–,3 Mounting evidence suggests that the effects of AEDs on the offspring can occur throughout pregnancy and possibly beyond with continued exposure.
Through international pregnancy registries, the rate of congenital malformations associated with first-trimester in utero AED exposure is one of the most widely studied outcomes.2 Results reflected in the American Academy of Neurology (AAN) guidelines show that valproic acid (VPA) use in the first trimester may contribute to the development of major congenital malformations.2 However, the effects of exposure to AEDs during brain development in the third trimester have been much less studied due to the need for sophisticated cognitive evaluation, behavioral testing, and prolonged follow-up. It is likely that in utero AED polytherapy and individual AEDs including VPA, phenobarbital, and phenytoin may lead to reduced cognition.2 The Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study,4 a prospective observational …
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