The Teratogenic Risk of Antiepileptic Drugs

Janz, Diéter

doi:10.1111/j.1528-1157.1975.tb04732.x

Cited by 98 publications

(27 citation statements)

References 31 publications

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“…The offspring of women who took folate antagonists during pregnancy, for example, methotrexate, aminopterin (4-pteroylglutamic acid), and anticonvulsants, appear to be at higher risk for oral clefts (Biale et al, 1975;Hecht et al, 1989;Hernandez-Diaz et al, 2000;Janz, 1975;Milunsky et al, 1989;Thiersch, 1952), and animal studies have demonstrated a teratogenic effect of antifolate factors and folate deficiency (DePaola and Mandella, 1981;Evans et al, 1951;Jordan et al, 1977). Finally, studies in humans have reported a statistically significant protective association between the use of folic acid and/or multivitamins and the risk for oral clefts Itikala et al, 2001;Loffredo et al, 2001;Mitchell et al, 2003;Shaw et al, 1995;van Rooij et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Folic acid–containing supplement consumption during pregnancy and risk for oral clefts: A meta‐analysis

Badovinac

Werler

Williams

et al. 2006

Birth Defects Research

136

103

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BACKGROUND: There is equivocal evidence in the published literature that folic acid supplementation during pregnancy may protect against the common congenital anomalies cleft lip with or without cleft palate (CLP) and cleft palate alone (CP). We undertook this meta-analysis to test the hypothesis that nonsyndromic oral cleft birth prevalences are different for those whose mothers took folic acid-containing supplements and for those whose mothers did not. METHODS: Human studies published in English were identified through MEDLINE, bibliography reviews, and contacting experts in the field. Within strata of prospective and case-control studies, CLP, CP, and all clefts, respectively, were analyzed using either a fixed or random effects model, as appropriate. We assessed for publication bias using Begg and Mazumdar's rank correlation and Egger's regressionbased tests. RESULTS: Five prospective studies were analyzed, yielding combined relative risks of 0.51 (95% CI: 0.32, 0.95) for CLP, 1.19 (95% CI: 0.43, 3.28) for CP, and 0.55 (95% CI: 0.32, 0.95) for all clefts. Twelve casecontrol studies were assessed, which resulted in combined relative risks of 0.77 (95% CI: 0.65, 0.90) for CLP, 0.80 (95% CI: 0.69, 0.93) for CP, and 0.78 (95% CI: 0.71, 0.85) for all clefts. CONCLUSIONS: In aggregate, our results support the hypothesis of a protective effect of folic acid-containing supplement intake during pregnancy on the risk for oral clefts, although this conclusion is tempered by the potential for bias and uncontrolled confounding. Birth Defects Research (Part A) 79:8-15, 2007.

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Section: Introductionmentioning

confidence: 99%

Folic acid–containing supplement consumption during pregnancy and risk for oral clefts: A meta‐analysis

Badovinac

Werler

Williams

et al. 2006

Birth Defects Research

136

103

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“…A comparative chart of the distribution of neurological disorders among various studies is given in Table 11.Epilepsy is a common neurological disorder characterized by a tendency to develop recurrent seizures 7 . Epidemiological studies have suggested that about 7% of epileptic females become pregnant during their lifetime and that approximately 0.5% of all pregnancies are complicated by epilepsy 8 ; 0.4% of patients had epilepsy in this report.…”

Section: Discussionmentioning

confidence: 79%

Neurological Disorders in Pregnancy and Puerperium

Shubha¹,

Rao²,

Raghavendra³

2017

IOSR JDMS

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“…Recent recommendations on the management of pregnant epileptic patients have been formulated in light of the dataalready discussed [76,113,155, 161, 1701.…”

Section: A Nagemen T Of the Pregnant Epileptic Pa Tien Tmentioning

confidence: 99%

Epilepsy in adults

Penry

1981

Annals of Neurology

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The past decade has seen advances in the management of patients with epilepsy. The development of practical long-term electroencephalographic techniques, with or without simultaneous video recording, has increased the accuracy of diagnosis of seizure types. The technique also provides clinicians and investigators with a method for establishing the clinical efficacy of antiepileptic drugs and determining their therapeutic serum concentrations. Computerized tomography has enhanced the identification of structural brain lesions. Most of the reported CT abnormalities consist of diffuse and focal atrophies, mild ventricular dilatations, and porencephalies. CT has detected tumors in 8 to 10% of the patients regardless of age or type of seizure involved. New concepts of antiepileptic drug therapy have developed from the recognition of pharmacological properties peculiar to each agent. Determination of serum antiepileptic drug levels has to be utilized to reduce the problem of pharmacokinetic variability from one patient to another and in the same patient at different times, so that dosage can be individualized to achieve maximum therapeutic effects with least toxicity. Review of the literature on pregnancy in epileptic women shows that a third to half experienced more seizures during gestation. Reduced serum levels of most antiepileptic drugs have recently been observed during gestation. Infants of epileptic women taking antiepileptic drugs have a two to three times greater risk for congenital anomalies than infants of nonepileptic women. However, with the exception of oxazolidinediones, evidence to date has not proved the teratogenicity of antiepileptic drugs. The role of genetic factors and the effect of seizures during pregnancy have not been determined. Modest progress has been made in epilepsy rehabilitation, but serious problems still remain. The unemployment rate of persons with epilepsy is twice the national average. Half of those who are successfully employed did not disclose their disorder at the time of employment. Several prognostic indicators have been reported, but the validity of many of these indicators is questionable. For example, does shorter life expectancy apply to all subgroups, or does it vary according to seizure type and cause? The life expectancy, treatment response, and probability of remission in epileptic persons must be reevaluated after consistent applications of current methods of epilepsy management.

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The Teratogenic Risk of Antiepileptic Drugs

Cited by 98 publications

References 31 publications

Folic acid–containing supplement consumption during pregnancy and risk for oral clefts: A meta‐analysis

Folic acid–containing supplement consumption during pregnancy and risk for oral clefts: A meta‐analysis

Neurological Disorders in Pregnancy and Puerperium

Epilepsy in adults

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