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