Skip to main content
SpringerLink
Log in

Antiepileptic Treatment in Pregnant Women: Morphological and Behavioural Effects

  • Chapter
  • First Online:
Pediatric Clinical Pharmacology

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 205))

Abstract

It is well established that children exposed to antiepileptic drugs (AEDs) in utero have an increased risk of adverse pregnancy outcomes including foetal growth retardation, major congenital malformations and impaired postnatal cognitive development. However, due to the significant maternal and foetal risks associated with uncontrolled epileptic seizures, AED treatment is generally maintained during pregnancy in the majority of women with active epilepsy. The prevalence of major malformations in children exposed to AEDs has ranged from 4 to 10%, 2–4 times higher than in the general population. More recent studies suggest a smaller increase in malformation rates. Malformation rates have consistently been higher in association with exposure to valproate than with carbamazepine and lamotrigine. Some prospective cohort studies also indicate reduced cognitive outcome in children exposed to valproate compared to carbamazepine and possibly lamotrigine. Information on pregnancy outcomes with newer generation AEDs other than lamotrigine are still insufficient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 389.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 499.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 499.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Adab N, Jacoby A, Smith D et al (2001) Additional educational needs in children born to mothers with epilepsy. J Neurol Neurosurg Psychiatry 70:15–21

    Article  PubMed  CAS  Google Scholar 

  • Adab N, Kini U, Vinten J et al (2004a) The longer term outcome of children born to mothers with epilepsy. J Neurol Neurosurg Psychiatry 75:1575–1583

    Article  PubMed  CAS  Google Scholar 

  • Adab N, Tudur SC, Vinten J et al (2004b) Common antiepileptic drugs in pregnancy in women with epilepsy (Cochrane Review) The Cochrane Library. Wiley, Chichester

    Google Scholar 

  • Amore BM, Kalhorn TF, Skiles GL et al (1997) Characterization of carbamazepine metabolism in a mouse model of carbamazepine teratogenicity. Drug Metab Dispos 25:953–962

    PubMed  CAS  Google Scholar 

  • Artama M, Auvinen A, Raudaskoski T et al (2005) Antiepileptic drug use of women with epilepsy and congenital malformations in offspring. Neurology 64:1874–1878

    Article  PubMed  CAS  Google Scholar 

  • Azarbayjani F, Danielsson BR (2002) Embryonic arrhythmia by inhibition of HERG channels: a common hypoxia-related teratogenic mechanism for antiepileptic drugs? Epilepsia 43:457–468

    Article  PubMed  CAS  Google Scholar 

  • Battino D, Tomson T (2007) Management of epilepsy during pregnancy. Drugs 67:2727–2746

    Article  PubMed  CAS  Google Scholar 

  • Battino D, Granata T, Binelli S et al (1992) Intrauterine growth in the offspring of epileptic mothers. Acta Neurol Scand 86:555–557

    Article  PubMed  CAS  Google Scholar 

  • Battino D, Kaneko S, Andermann E et al (1999) Intrauterine growth in the offspring of epileptic women: a prospective multicenter study. Epilepsy Res 36:53–60

    Article  PubMed  CAS  Google Scholar 

  • Bennett GD, Amore BM, Finnell RH et al (1996) Teratogenicity of carbamazepine-10, 11-epoxide and oxcarbazepine in the SWV mouse. J Pharmacol Exp Ther 279:1237–1242

    PubMed  CAS  Google Scholar 

  • Bittigau P, Sifringer M, Genz K et al (2002) Antiepileptic drugs and apoptotic neurodegeneration in the developing brain. Proc Natl Acad Sci USA 99:15089–15094

    Article  PubMed  CAS  Google Scholar 

  • Buehler BA, Delimont D, van Waes M et al (1990) Prenatal prediction of risk of the fetal hydantoin syndrome. N Engl J Med 322:1567–1572

    Article  PubMed  CAS  Google Scholar 

  • Buehler BA, Rao V, Finnell RH (1994) Biochemical and molecular teratology of fetal hydantoin syndrome. Neurol Clin 12:741–748

    PubMed  CAS  Google Scholar 

  • Canger R, Battino D, Canevini MP et al (1999) Malformations in offspring of women with epilepsy: a prospective study. Epilepsia 40:1231–1236

    Article  PubMed  CAS  Google Scholar 

  • Choulika S, Harvey E, Holmes LB (1999) Effect of antiepileptic drugs (AED) on fetal growth: assessment at birth. Teratology 59:388

    Google Scholar 

  • Cunnington M, Ferber S, Quartey G (2007) Effect of dose on the frequency of major birth defects following fetal exposure to lamotrigine monotherapy in an international observational study. Epilepsia 48:1207–1210

    Article  PubMed  CAS  Google Scholar 

  • Danielsson B, Skold AC, Azarbayjani F et al (2000) Pharmacokinetic data support pharmacologically induced embryonic dysrhythmia as explanation to Fetal Hydantoin Syndrome in rats. Toxicol Appl Pharmacol 163:164–175

    Article  PubMed  CAS  Google Scholar 

  • Dansky LV, Andermann E, Rosenblatt D et al (1987) Anticonvulsants, folate levels, and pregnancy outcome: a prospective study. Ann Neurol 21:176–182

    Article  PubMed  CAS  Google Scholar 

  • Dean JC, Moore SJ, Osborne A et al (1999) Fetal anticonvulsant syndrome and mutation in the maternal MTHFR gene. Clin Genet 56:216–220

    Article  PubMed  CAS  Google Scholar 

  • Dean JC, Hailey H, Moore SJ et al (2002) Long term health and neurodevelopment in children exposed to antiepileptic drugs before birth. J Med Genet 39:251–259

    Article  PubMed  CAS  Google Scholar 

  • Dessens AB, Cohen-Kettenis PT, Mellenbergh GJ et al (2001) Association of prenatal phenobarbital and phenytoin exposure with genital anomalies and menstrual disorders. Teratology 64:181–188

    Article  PubMed  CAS  Google Scholar 

  • Dolk H, Jentink J, Loane M et al (2008) Does lamotrigine use in pregnancy increase orofacial cleft risk relative to other malformations? Neurology 71:714–722

    Article  PubMed  CAS  Google Scholar 

  • Eriksson K, Viinikainen K, Monkkonen A et al (2005) Children exposed to valproate in utero-population based evaluation of risks and confounding factors for long-term neurocognitive development. Epilepsy Res 65:189–200

    Article  PubMed  CAS  Google Scholar 

  • Finnell RH (1991) Genetic differences in susceptibility to anticonvulsant drug-induced developmental defects. Pharmacol Toxicol 69:223–227

    PubMed  CAS  Google Scholar 

  • Finnell RH, Dansky LV (1991) Parental epilepsy, anticonvulsant drugs, and reproductive outcome: epidemiologic and experimental findings spanning three decades; 1: animal studies. Reprod Toxicol 5:281–299

    Article  PubMed  CAS  Google Scholar 

  • Finnell RH, Bennett GD, Slattery JT et al (1995) Effect of treatment with phenobarbital and stiripentol on carbamazepine-induced teratogenicity and reactive metabolite formation. Teratology 52:324–332

    Article  PubMed  CAS  Google Scholar 

  • Fonager K, Larsen H, Pedersen L et al (2000) Birth outcomes in women exposed to anticonvulsant drugs. Acta Neurol Scand 101:289–294

    Article  PubMed  CAS  Google Scholar 

  • Fried S, Kozer E, Nulman I et al (2004) Malformation rates in children of women with untreated epilepsy: a meta-analysis. Drug Saf 27:197–202

    Article  PubMed  Google Scholar 

  • Gaily E (1991) Development and growth in children of epileptic mothers. A prospective controlled study. Acta Obstet Gynecol Scand 70:631–632

    Article  Google Scholar 

  • Gaily E, Granstrom ML, Hiilesmaa V et al (1988) Minor anomalies in offspring of epileptic mothers. J Pediatr 112:520–529

    Article  PubMed  CAS  Google Scholar 

  • Gaily E, Kantola-Sorsa E, Granstrom ML (1990) Specific cognitive dysfunction in children with epileptic mothers. Dev Med Child Neurol 32:403–414

    Article  PubMed  CAS  Google Scholar 

  • Gaily E, Kantola-Sorsa E, Hiilesmaa V et al (2004) Normal intelligence in children with prenatal exposure to carbamazepine. Neurology 62:28–32

    PubMed  CAS  Google Scholar 

  • German J, Ehlers KH, Kowal A et al (1970) Possible teratogenicity of trimethadione and paramethadione. Lancet 2:261–262

    Article  PubMed  CAS  Google Scholar 

  • Hanson JW, Myrianthopoulos NC, Harvey MA et al (1976) Risks to the offspring of women treated with hydantoin anticonvulsants, with emphasis on the fetal hydantoin syndrome. J Pediatr 89:662–668

    Article  PubMed  CAS  Google Scholar 

  • Harden CL, Meador KJ, Pennell PB et al (2009) Management issues for women with epilepsy – focus on pregnancy (an evidence-based review): II. Teratogenesis and perinatal outcomes: report of the Quality Standards Subcommittee and Therapeutics and Technology Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia 50:1237–1246

    Article  PubMed  Google Scholar 

  • Hernandez-Diaz S, Smith CR, Wyszynski DF et al (2007) Risk of major malformations among infants exposed to carbamazepine during pregnancy. Birth Def Res 79:357

    Google Scholar 

  • Hiilesmaa VK, Teramo K, Granstrom ML et al (1981) Fetal head growth retardation associated with maternal antiepileptic drugs. Lancet 2:165–167

    Article  PubMed  CAS  Google Scholar 

  • Holmes LB, Rosenberger PB, Harvey EA et al (2000) Intelligence and physical features of children of women with epilepsy. Teratology 61:196–202

    Article  PubMed  CAS  Google Scholar 

  • Holmes LB, Harvey EA, Coull BA et al (2001) The teratogenicity of anticonvulsant drugs. N Engl J Med 344:1132–1138

    Article  PubMed  CAS  Google Scholar 

  • Holmes LB, Wyszynski DF, Lieberman E (2004) The AED (antiepileptic drug) pregnancy registry: a 6-year experience. Arch Neurol 61:673–678

    Article  PubMed  Google Scholar 

  • Holmes LB, Baldwin EJ, Smith CR et al (2008a) Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy. Neurology 70:2152–2158

    Article  PubMed  CAS  Google Scholar 

  • Holmes LB, Smith CR, Herndandez-Diaz S (2008b) Pregnancy registries: larger sample sizes essential. Birth Def Res A 82:307

    Google Scholar 

  • Hunt S, Craig J, Russell A et al (2006) Levetiracetam in pregnancy: preliminary experience from the UK Epilepsy and Pregnancy Register. Neurology 67:1876–1879

    Article  PubMed  CAS  Google Scholar 

  • Hunt S, Russell A, Smithson WH et al (2008) Topiramate in pregnancy: preliminary experience from the UK Epilepsy and Pregnancy Register. Neurology 71:272–276

    Article  PubMed  CAS  Google Scholar 

  • Hvas CL, Henriksen TB, Ostergaard JR et al (2000) Epilepsy and pregnancy: effect of antiepileptic drugs and lifestyle on birthweight. BJOG 107:896–902

    Article  PubMed  CAS  Google Scholar 

  • Kaaja E, Kaaja R, Hiilesmaa V (2003) Major malformations in offspring of women with epilepsy. Neurology 60:575–579

    PubMed  Google Scholar 

  • Kallen AJ (1994) Maternal carbamazepine and infant spina bifida. Reprod Toxicol 8:203–205

    Article  PubMed  CAS  Google Scholar 

  • Kaneko S, Battino D, Andermann E et al (1999) Congenital malformations due to antiepileptic drugs. Epilepsy Res 33:145–158

    Article  PubMed  CAS  Google Scholar 

  • Kini U, Adab N, Vinten J et al (2006) Dysmorphic features: an important clue to the diagnosis and severity of fetal anticonvulsant syndromes. Arch Dis Child Fetal Neonatal Ed 91:F90–F95

    Article  PubMed  CAS  Google Scholar 

  • Kjaer D, Horvath-Puho E, Christensen J et al (2007) Use of phenytoin, phenobarbital, or diazepam during pregnancy and risk of congenital abnormalities: a case-time-control study. Pharmacoepidemiol Drug Saf 16:181–188

    Article  PubMed  CAS  Google Scholar 

  • Kluger BM, Meador KJ (2008) Teratogenicity of antiepileptic medications. Semin Neurol 28:328–335

    Article  PubMed  Google Scholar 

  • Kondo T, Kaneko S, Amano Y et al (1996) Preliminary report on teratogenic effects of zonisamide in the offspring of treated women with epilepsy. Epilepsia 37:1242–1244

    Article  PubMed  CAS  Google Scholar 

  • Lillibridge JH, Amore BM, Slattery JT et al (1996) Protein-reactive metabolites of carbamazepine in mouse liver microsomes. Drug Metab Dispos 24:509–514

    PubMed  CAS  Google Scholar 

  • Lindhout D, Omtzigt JG (1992) Pregnancy and the risk of teratogenicity. Epilepsia 33:S41–S48

    Article  PubMed  Google Scholar 

  • Lindhout D, Schmidt D (1986) In-utero exposure to valproate and neural tube defects. Lancet 1:1392–1393

    Article  PubMed  CAS  Google Scholar 

  • Lindhout D, Hoppener RJ, Meinardi H (1984) Teratogenicity of antiepileptic drug combinations with special emphasis on epoxidation (of carbamazepine). Epilepsia 25:77–83

    Article  PubMed  CAS  Google Scholar 

  • Long L (2003) Levetiracetam monotherapy during pregnancy: a case series. Epilepsy Behav 4:447–448

    Article  PubMed  Google Scholar 

  • Malm H, Kajantie E, Kivirikko S et al (2002) Valproate embryopathy in three sets of siblings: further proof of hereditary susceptibility. Neurology 59:630–633

    PubMed  CAS  Google Scholar 

  • Martz F, Failinger C 3rd, Blake DA (1977) Phenytoin teratogenesis: correlation between embryopathic effect and covalent binding of putative arene oxide metabolite in gestational tissue. J Pharmacol Exp Ther 203:231–239

    PubMed  CAS  Google Scholar 

  • Meador K, Reynolds MW, Crean S et al (2008) Pregnancy outcomes in women with epilepsy: a systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res 81:1–13

    Article  PubMed  Google Scholar 

  • Meador KJ, Baker GA, Browning N et al (2009) Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs. N Engl J Med 360:1597–1605

    Article  PubMed  CAS  Google Scholar 

  • Meadow SR (1968) Anticonvulsant drugs and congenital abnormalities. Lancet 2:1296

    Article  PubMed  CAS  Google Scholar 

  • Meischenguiser R, D’Giano CH, Ferraro SM (2004) Oxcarbazepine in pregnancy: clinical experience in Argentina. Epilepsy Behav 5:163–167

    Article  PubMed  Google Scholar 

  • Montouris G (2003) Gabapentin exposure in human pregnancy: results from the Gabapentin Pregnancy Registry. Epilepsy Behav 4:310–317

    Article  PubMed  Google Scholar 

  • Moore SJ, Turnpenny P, Quinn A et al (2000) A clinical study of 57 children with fetal anticonvulsant syndromes. J Med Genet 37:489–497

    Article  PubMed  CAS  Google Scholar 

  • Morrow J, Russell A, Guthrie E et al (2006) Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy Register. J Neurol Neurosurg Psychiatry 77:193–198

    Article  PubMed  CAS  Google Scholar 

  • Morrow JI, Hunt SJ, Russell AJ et al (2009) Folic acid use and major congenital malformations in offspring of women with epilepsy: a prospective study from the UK Epilepsy and Pregnancy Register. J Neurol Neurosurg Psychiatry 80:506–511

    Article  PubMed  CAS  Google Scholar 

  • MRC Vitamin Study Research Group (1991) Prevention of neural tube defects: results of the Medical Research Council Vitamin Study [see comments]. Lancet 338:131–137

    Article  Google Scholar 

  • Ogawa Y, Kaneko S, Otani K et al (1991) Serum folic acid levels in epileptic mothers and their relationship to congenital malformations. Epilepsy Res 8:75–78

    Article  PubMed  CAS  Google Scholar 

  • Ornoy A, Zvi N, Arnon J et al (2008) The outcome of pregnancy following topiramate treatment: a study on 52 pregnancies. Reprod Toxicol 25:388–389

    Article  PubMed  CAS  Google Scholar 

  • Pantarotto C, Arboix M, Sezzano P et al (1982) Studies on 5,5-diphenylhydantoin irreversible binding to rat liver microsomal proteins. Biochem Pharmacol 31:1501–1507

    Article  PubMed  CAS  Google Scholar 

  • Parman T, Chen G, Wells PG (1998) Free radical intermediates of phenytoin and related teratogens. Prostaglandin H synthase-catalyzed bioactivation, electron paramagnetic resonance spectrometry, and photochemical product analysis. J Biol Chem 273:25079–25088

    Article  PubMed  CAS  Google Scholar 

  • Perucca E, Tomson T (2006) Prenatal exposure to antiepileptic drugs. Lancet 367:1467–1469

    Article  PubMed  Google Scholar 

  • Puho EH, Szunyogh M, Metneki J et al (2007) Drug treatment during pregnancy and isolated orofacial clefts in Hungary. Cleft Palate Craniofac J 44:194–202

    Article  PubMed  Google Scholar 

  • Rane A, Peng D (1985) Phenytoin enhances epoxide metabolism in human fetal liver cultures. Drug Metab Dispos 13:382–385

    PubMed  CAS  Google Scholar 

  • Rasalam AD, Hailey H, Williams JH et al (2005) Characteristics of fetal anticonvulsant syndrome associated autistic disorder. Dev Med Child Neurol 47:551–555

    Article  PubMed  CAS  Google Scholar 

  • Raymond GV, Buehler BA, Finnell RH et al (1995) Anticonvulsant teratogenesis: 3. Possible metabolic basis. Teratology 51:55–56

    Article  PubMed  CAS  Google Scholar 

  • Registry SMB http://www.janusinfo.org/. Accessed 2009

  • Rosa FW (1991) Spina bifida in infants of women treated with carbamazepine during pregnancy. N Engl J Med 324:674–677

    Article  PubMed  CAS  Google Scholar 

  • Roy D, Snodgrass WR (1990) Covalent binding of phenytoin to protein and modulation of phenytoin metabolism by thiols in A/J mouse liver microsomes. J Pharmacol Exp Ther 252:895–900

    PubMed  CAS  Google Scholar 

  • Samrén EB, van Duijn CM, Koch S et al (1997) Maternal use of antiepileptic drugs and the risk of major congenital malformations: a joint European prospective study of human teratogenesis associated with maternal epilepsy. Epilepsia 38:981–990

    Article  PubMed  Google Scholar 

  • Samrén EB, van Duijn CM, Christiaens GC et al (1999) Antiepileptic drug regimens and major congenital abnormalities in the offspring. Ann Neurol 46:739–746

    Article  PubMed  Google Scholar 

  • Scolnik D, Nulman I, Rovet J et al (1994) Neurodevelopment of children exposed in utero to phenytoin and carbamazepine monotherapy. JAMA 271:767–770

    Article  PubMed  CAS  Google Scholar 

  • Speidel BD, Meadow SR (1972) Maternal epilepsy and abnormalities of fetus and the newborn. Lancet 2:839–843

    Article  PubMed  CAS  Google Scholar 

  • Spina E, Perugi G (2004) Antiepileptic drugs: indications other than epilepsy. Epileptic Disord 6:57–75

    PubMed  Google Scholar 

  • Strickler SM, Dansky LV, Miller MA et al (1985) Genetic predisposition to phenytoin-induced birth defects. Lancet 2:746–749

    Article  PubMed  CAS  Google Scholar 

  • ten Berg K, Samrén EB, van Oppen AC et al (2005) Levetiracetam use and pregnancy outcome. Reprod Toxicol 20:175–178

    Article  PubMed  CAS  Google Scholar 

  • Thomas SV, Ajaykumar B, Sindhu K et al (2008) Motor and mental development of infants exposed to antiepileptic drugs in utero. Epilepsy Behav 13:229–236

    Article  PubMed  Google Scholar 

  • Tomson T, Battino D (2005) Teratogenicity of antiepileptic drugs: state of the art. Curr Opin Neurol 18:135–140

    Article  PubMed  CAS  Google Scholar 

  • Tomson T, Battino D (2009) The management of epilepsy in pregnancy. In: Shorvon S, Pedley TA (eds) The epilepsies 3: blue books of neurology. Saunders Elsevier, Philadelphia, pp 241–264

    Google Scholar 

  • Tomson T, Hiilesmaa V (2007) Epilepsy in pregnancy. BMJ 335:769–773

    Article  PubMed  Google Scholar 

  • Tomson T, Beghi E, Sundqvist A et al (2004a) Medical risks in epilepsy: a review with focus on physical injuries, mortality, traffic accidents and their prevention. Epilepsy Res 60:1–16

    Article  PubMed  Google Scholar 

  • Tomson T, Perucca E, Battino D (2004b) Navigating toward fetal and maternal health: the challenge of treating epilepsy in pregnancy. Epilepsia 45:1171–1175

    Article  PubMed  Google Scholar 

  • Tomson T, Battino D, Craig J et al (2010) Pregnancy registries: differences, similarities, and possible harmonization. Report of a working group of the Commission on Therapeutic Strategies of the International League Against Epilepsy. Epilepsia 51:909–915

    PubMed  Google Scholar 

  • Vajda FJ, Hitchcock A, Graham J et al (2007) The Australian Register of Antiepileptic Drugs in Pregnancy: the first 1002 pregnancies. Aust N Z J Obstet Gynaecol 47:468–474

    Article  PubMed  Google Scholar 

  • Veiby G, Daltveit AK, Engelsen BA et al (2009) Pregnancy, delivery, and outcome for the child in maternal epilepsy. Epilepsia 50:2130–2139

    Article  PubMed  Google Scholar 

  • Viinikainen K, Heinonen S, Eriksson K et al (2006) Community-based, prospective, controlled study of obstetric and neonatal outcome of 179 pregnancies in women with epilepsy. Epilepsia 47:186–192

    Article  PubMed  Google Scholar 

  • Vinten J, Adab N, Kini U et al (2005) Neuropsychological effects of exposure to anticonvulsant medication in utero. Neurology 64:949–954

    Article  PubMed  CAS  Google Scholar 

  • Volcik KA, Shaw GM, Lammer EJ et al (2003) Evaluation of infant methylenetetrahydrofolate reductase genotype, maternal vitamin use, and risk of high versus low level spina bifida defects. Birth Defects Res A Clin Mol Teratol 67:154–157

    Article  PubMed  CAS  Google Scholar 

  • Wells PG, Winn LM (1996) Biochemical toxicology of chemical teratogenesis. Crit Rev Biochem Mol Biol 31:1–40

    Article  PubMed  CAS  Google Scholar 

  • Wells PG, Kim PM, Laposa RR et al (1997) Oxidative damage in chemical teratogenesis. Mutat Res 396:65–78

    PubMed  CAS  Google Scholar 

  • Wide K, Winbladh B, Tomson T et al (2000) Body dimensions of infants exposed to antiepileptic drugs in utero: observations spanning 25 years. Epilepsia 41:854–861

    Article  PubMed  CAS  Google Scholar 

  • Wide K, Henning E, Tomson T et al (2002) Psychomotor development in preschool children exposed to antiepileptic drugs in utero. Acta Paediatr 91:409–414

    Article  PubMed  CAS  Google Scholar 

  • Wide K, Winbladh B, Kallen B (2004) Major malformations in infants exposed to antiepileptic drugs in utero, with emphasis on carbamazepine and valproic acid: a nation-wide, population-based register study. Acta Paediatr 93:174–176

    Article  PubMed  CAS  Google Scholar 

  • Wyszynski DF, Nambisan M, Surve T et al (2005) Increased rate of major malformations in offspring exposed to valproate during pregnancy. Neurology 64:961–965

    Article  PubMed  CAS  Google Scholar 

  • Zhu H, Kartiko S, Finnell RH (2009) Importance of gene-environment interactions in the etiology of selected birth defects. Clin Genet 75:409–423

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Neuroscience, Karolinska Institutet, S-171 76, Stockholm, Sweden

    Torbjörn Tomson

  2. Department of Neurophysiopathology and Epilepsy Centre, IRCCS Foundation Carlo Besta, Neurological Institute, Milan, Italy

    Dina Battino

Authors
  1. Torbjörn Tomson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dina Battino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Torbjörn Tomson .

Editor information

Editors and Affiliations

  1. Klinik für Kinder- und Jugendmedizin, Univ.Klinikum Marburg, Baldingerstr. 12, Marburg, 35043, Germany

    Hannsjörg W. Seyberth

  2. Karolinska Institutet, Dept. Laboratory Medicine, Karolinska University Hostpital, Stockholm, 141 86, Sweden

    Anders Rane

  3. für Klinische Pharmakologie (IKP), Dr. Margarete Fischer-Bosch Institut, Auerbachstr. 112, Stuttgart, 70376, Germany

    Matthias Schwab

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Tomson, T., Battino, D. (2011). Antiepileptic Treatment in Pregnant Women: Morphological and Behavioural Effects. In: Seyberth, H., Rane, A., Schwab, M. (eds) Pediatric Clinical Pharmacology. Handbook of Experimental Pharmacology, vol 205. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-20195-0_15

Download citation

Publish with us

Policies and ethics

Search

Navigation