4
Treatment
3C. Clinicians must avoid the use of valproic acid in PWECP to minimize
the risk of MCMs (composite outcome) or neural tube defects (NTDs),
if clinically feasible (Level A).
3D. Clinicians must counsel PWECP who are treated with, or are
considering starting, valproic acid that the risk of any MCM is the
highest with valproic acid as compared to other studied ASMs (Level A).
3E. To reduce the risk of cardiac malformations, clinicians must avoid the
use of phenobarbital in PWECP, if clinically feasible (Level A).
3F. To reduce the risk of oral clefts, clinicians should avoid the use of
phenobarbital and topiramate in PWECP, if clinically feasible (Level B).
3G. To reduce the risk of urogenital and renal malformations, clinicians
should avoid the use of valproic acid in PWECP, if clinically feasible
(Level B).
3H. To enable early detection and timely intervention of MCMs,
obstetricians should recommend fetal screening for MCMs (e.g., a
detailed anatomical ultrasound, where available) for PWECP who are
treated with any ASM during pregnancy (Level B).
3I. To enable early detection and timely intervention of congenital
heart defects, obstetricians should recommend screening cardiac
investigations of the fetus among PWECP who are treated with
phenobarbital during pregnancy (Level B).
Perinatal Outcomes
4A. Clinicians should counsel PWECP that the prevalence of intrauterine
death does not differ among different ASM exposures in monotherapy
(Level B).
4B. Clinicians should avoid the use of valproic acid or topiramate
in PWECP to minimize the risk of offspring being born small for
gestational age (SGA), if clinically feasible (Level B).
4C. To enable early identification of fetal growth restriction, obstetricians
should recommend screening of fetal growth throughout pregnancy
among PWECP who are treated with valproic acid or topiramate (Level B).
