Neurological teratogenic effects of antiepileptic drugs during pregnancy

Abstract

Epilepsy is one of the few neurologic disorders that requires a constant treatment during pregnancy. Epilepsy affects 0.3-0.8% of pregnant women. Prescription of antiepileptic drugs (AEDs) to pregnant women with epilepsy requires monitoring and maintaining a balance between limiting seizures and decreasing fetal exposure to the potential teratogenic effects. AEDs are also commonly used for psychiatric disorders, pain disorders, and migraines. The types of malformations that can result in fetuses exposed to AEDs include minor anomalies, major congenital malformations, intrauterine growth retardation, cognitive dysfunction, low IQ, microcephaly, and infant mortality. In the present review, we analyzed and summarized the current understanding of neurological development in fetuses that are exposed to various AEDs administered to pregnant epileptic women.

Keywords: AEDs; antiepileptic drugs; epilepsy; neurology; pregnancy; teratology.

Figure 1.

Various hypotheses that explain the teratogenecity of AEDs. There may be multiple mechanisms that lead to the formation of cognitive defects in fetuses, including ischemic condition, neural suppression, decreased folate absorption, neural apoptosis and an increase in free radical formation (5). AEDs, antiepileptic drugs.

Figure 2.

Mechanism of AEDs. Carbamazepine, phenytoin, lamotrigine and valproate work by inactivating voltage-gated sodium channels (18). AEDs, antiepileptic drugs.