Antiepileptic drugs as human teratogens

BACKGROUND: There is still uncertainty concerning the risk of fetal malformation associated with the intake of various individual antiepileptic drugs in pregnant women. OBJECTIVE: To assess the better-quality available evidence concerning the fetal hazards from exposure to antiepileptic drug monotherapy during human pregnancy. METHOD: Examination of the available English language literature, particularly that dealing with individual antiepileptic drugs used in monotherapy, in the larger case series with better-quality internal comparison data. CONCLUSIONS: There is reasonable evidence that valproate is a significant teratogen during therapeutic use in women; the other older antiepileptic drugs (phenobarbitone, phenytoin, carbamazepine) probably have some teratogenic potential, but less than valproate; the situation regarding the more recently marketed antiepileptic drugs is not yet clear.