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May 22, 2012; 78 (21) Articles

Comparative safety of antiepileptic drugs during pregnancy

S. Hernández-Díaz, C.R. Smith, A. Shen, R. Mittendorf, W.A. Hauser, M. Yerby, L.B. Holmes, For the North American AED Pregnancy Registry
First published May 2, 2012, DOI: https://doi.org/10.1212/WNL.0b013e3182574f39
S. Hernández-Díaz
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C.R. Smith
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A. Shen
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R. Mittendorf
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W.A. Hauser
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M. Yerby
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Citation
Comparative safety of antiepileptic drugs during pregnancy
S. Hernández-Díaz, C.R. Smith, A. Shen, R. Mittendorf, W.A. Hauser, M. Yerby, L.B. Holmes, For the North American AED Pregnancy Registry
Neurology May 2012, 78 (21) 1692-1699; DOI: 10.1212/WNL.0b013e3182574f39

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Abstract

Objective: To assess the safety of the newer antiepileptic drugs (AEDs) during pregnancy.

Methods: The study population was pregnant women who enrolled in the North American AED Pregnancy Registry between 1997 and 2011. Data on AED use and maternal characteristics were collected through phone interviews at enrollment, at 7 months' gestation, and postpartum. Malformations were confirmed by medical records. The risk of major malformations was calculated among infants exposed to specific AEDs in monotherapy during the first trimester of pregnancy and among an unexposed group. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated with logistic regression.

Results: The risk of major malformations was 9.3% (30 of 323) for valproate, 5.5% (11 of 199) for phenobarbital, 4.2% (15 of 359) for topiramate, 3.0% (31 of 1.033) for carbamazepine, 2.9% (12 of 416) for phenytoin, 2.4% (11 of 450) for levetiracetam, and 2.0% (31 of 1,562) for lamotrigine. Compared with lamotrigine, the RR was 5.1 (95% CI 3.0–8.5) for valproate, 2.9 (1.4–5.8) for phenobarbital, and 2.2 (1.2–4.0) for topiramate. The proportion of women with epilepsy who had seizures during pregnancy ranged from 23% for valproate to 31% for lamotrigine. Valproate was associated with a higher risk of neural tube defects, hypospadias, cardiac defects, and oral clefts and phenobarbital with a higher risk of cardiac defects and oral clefts; 5 infants exposed to topiramate (1.4%) had a cleft lip.

Conclusions: AEDs such as valproate and phenobarbital were associated with a higher risk of major malformations than newer AEDs such as lamotrigine and levetiracetam. Topiramate was associated with an increased risk of cleft lip compared with that of a reference population.

GLOSSARY

AED=
antiepileptic drug;
CI=
confidence interval;
RR=
relative risk

Footnotes

  • North American AED Pregnancy Registry Coinvestigators are listed on the Neurology® Web site at www.neurology.org.

  • Study funding: The North American AED Pregnancy Registry has been supported by funds provided by Abbott, Eisai, Novartis, Ortho-McNeil, Pfizer, and Sunovian Pharmaceuticals. Contributors to the North American AED Pregnancy Registry include Aurobindo Pharma, Dr. Reddy's laboratories, GlaxoSmithKline, Sandoz, and Teva.

  • Supplemental data at www.neurology.org

  • Received August 30, 2011.
  • Accepted January 25, 2012.
  • Copyright © 2012 by AAN Enterprises, Inc.
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Disputes & Debates: Rapid online correspondence

  • Response to Maheshwari et al.
    • Sonia Hernandez-Diaz, Associate Professor, Harvard School of Public Healthshernan@hsph.harvard.edu
    • Lewis B. Holmes, Boston, MA, USA
    Submitted September 07, 2012
  • Are newer antiepileptics really safer?
    • Amit Maheshwari, senior resident neurology, SAIMS Indore Indianaman_amit@yahoo.com
    • Amit Maheshwari,Sunil Athale,O.P.Lekhra,Kapil Telang-all Indore India
    Submitted August 28, 2012
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