Effect of anti-epileptic drug therapy on the unborn child

Antiepileptic drugs have been shown to be teratogenic, affect children's physical development and have neurodevelopmental effects. These drug-related effects are part of the major burden of epilepsy. Individual drugs need to be assessed via prospective studies, possible only by using pregnancy registers complying with ethical guidelines. Monotherapy data indicate valproate to be the most teratogenic drug, although it is the most effective drug and its teratogenicity is dose-related. To the author's knowledge no specific malformations have clearly been proven to be attributable to a specific drug with the exception of valproate. Other antiepileptic drugs appear to be mildly teratogenic and newer drugs are possibly safer. A balance must be achieved between efficacy and teratdgenicity. An outline is given of the problems of seizure control, polytherapy issues and lack of specific malformations ascribed to any individual drugs, and a brief reference to cognitive changes is presented. (C) 2013 Elsevier Ltd. All rights reserved.