Selecting a Treatment Regimen
Table 1. Specific Fetal Risks
Agent Specific MCMs Level of Evidence
VPA neural tube defects, facial cles B
hypospadias C
PHT cle palate C
CBZ posterior cle palate C
PB cardiac malformations C
Cognitive Teratogenesis (Poor Cognitive Outcomes)
Î There is probably no increased risk in the offspring of WWE not taking AEDs
(Level B).
Î Consider monotherapy instead of polytherapy for WWE taking AEDs during
pregnancy, if possible, to reduce risk (Level B).
Î Consider avoiding VPA use as compared to CBZ use (Level B) and as
compared to PHT use (Level C), if possible, to reduce risk.
Î Consider avoiding PB and PHT use, if possible, to reduce risk (Level C).
Small for Gestational Age (SGA)
Î The offspring of WWE taking AEDs during pregnancy probably have an
increased risk of SGA (Level B).
Î Further, consider AED use in WWE during pregnancy in the differential
diagnosis of SGA in their offspring (Level B).
Low Apgar
Î The offspring of WWE taking AEDs during pregnancy possibly have an
increased risk of 1-minute Apgar scores < 7 (Level C).
Î Further, consider AED use in WWE during pregnancy in the differential
diagnosis of a 1-minute Apgar score < 7 in their offspring (Level C).
Reducing Risk During Pregnancy
MCMs
Î If possible, avoid first-trimester use of AED polytherapy (Level B), especially
polytherapy with VPA.
Î If possible, avoid first trimester use of VPA in polytherapy (Level B) and
monotherapy (Level C).
