Teratogenicity of Anticonvulsive Medications

The report by Feldman et al in this issue of theJournal(see p 1389) further indicts trimethadione, of the oxazolidinedione class of drugs, as one of the most potent teratogenic agents yet recognized in man. More than 80% of reported conceptuses exposed to trimethadione in utero have either been spontaneously aborted or malformed at birth. The phenotype has been similar in affected individuals and has been noted in the offspring of women who received trimethadione as the only anticonvulsant medication during pregnancy; hence the fetal trimethadione syndrome designation seems appropriate. The dysmorphic facies with a Mephistophelian upward slant to the eyebrows and the aberrant auricles appear to be the most consistent and unusual features along with mild to moderate growth deficiency. The most serious consequence is mental deficiency and the most frequent major malformations are cleft lip and/or cleft palate and cardiac defects. The concern about the teratogenic impact