Use of Antiepileptic Medications in Pregnancy in Relation to Risks of Birth Defects

Martha M Werler; Katherine A Ahrens; Jaclyn L.F Bosco; Allen A Mitchell; Marlene T Anderka; Suzanne M Gilboa; Lewis B Holmes; National Birth Defects Prevention Study

doi:10.1016/j.annepidem.2011.08.002

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Use of Antiepileptic Medications in Pregnancy in Relation to Risks of Birth Defects

Journal article

Peer reviewed

Use of Antiepileptic Medications in Pregnancy in Relation to Risks of Birth Defects

Martha M Werler, Katherine A Ahrens, Jaclyn L.F Bosco, Allen A Mitchell, Marlene T Anderka, Suzanne M Gilboa, Lewis B Holmes and National Birth Defects Prevention Study

Annals of epidemiology, Vol.21(11), pp.842-850

2011

DOI: 10.1016/j.annepidem.2011.08.002

PMCID: PMC4816042

PMID: 21982488

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Abstract

To evaluate use of specific antiepileptic drugs (AEDs) in pregnancy in relation to specific birth defects. Using data from the National Birth Defects Prevention Study, we assessed use of AEDs and the risk of neural tube defects (NTDs), oral clefts (OCs), heart defects (HDs), hypospadias, and other major birth defects, taking specific agent, timing, and indication into consideration. Drug-specific increased risks were observed for valproic acid in relation to NTDs [adjusted odds ratio (aOR), 9.7;, 95% confidence interval (CI), 3.4–27.5], OCs (aOR, 4.4; 95% CI, 1.6–12.2), HDs (aOR, 2.0; 95% CI, 0.78–5.3), and hypospadias (aOR. 2.4; 95% CI, 0.62–9.0), and for carbamazapine in relation to NTDs (aOR, 5.0; 95% CI, 1.9–12.7). Epilepsy history without AED use did not seem to increase risk. Valproic acid, which current guidelines suggest should be avoided in pregnancy, was most notable in terms of strength and breadth of its associations. Carbamazapine was associated with NTDs, even after controlling for folic acid use. Sample sizes were still too small to adequately assess risks of less commonly used AEDs, but our findings support further study to identify lower risk options for pregnant women.

Pregnancy

Anti-epileptic drugs

Birth defects

Details

Title: Subtitle: Use of Antiepileptic Medications in Pregnancy in Relation to Risks of Birth Defects
Creators: Martha M Werler - Slone Epidemiology Center at Boston University, Boston, MA
Katherine A Ahrens - Slone Epidemiology Center at Boston University, Boston, MA
Jaclyn L.F Bosco - Department of Epidemiology, Boston University School of Public Health, Boston, MA
Allen A Mitchell - Slone Epidemiology Center at Boston University, Boston, MA
Marlene T Anderka - Massachusetts Department of Public Health, Boston, MA
Suzanne M Gilboa - National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
Lewis B Holmes - Genetics and Teratology, Massachusetts General Hospital for Children, Boston, MA
National Birth Defects Prevention Study
Contributors: Paul A Romitti (Contributor) - University of Iowa, Epidemiology
Resource Type: Journal article
Publication Details: Annals of epidemiology, Vol.21(11), pp.842-850
DOI: 10.1016/j.annepidem.2011.08.002
PMID: 21982488
PMCID: PMC4816042
NLM abbreviation: Ann Epidemiol
ISSN: 1047-2797
eISSN: 1873-2585
Publisher: Elsevier Inc
Grant note: U01DD000493 / Centers for Disease Control and Prevention
Language: English
Date published: 2011
Academic Unit: Epidemiology; Biostatistics
Record Identifier: 9984214688502771

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