Teratogenicity and Anticonvulsants: Lessons From Neurology to Psychiatry

Anticonvulsants are considered first-line treatments for epilepsy, and some also exert useful effects as mood stabilizers for the treatment of bipolar (manic-depressive) disorder. Much of the research on anticonvulsant use during pregnancy has been done by neurologists studying women with epilepsy. Anticonvulsant use during pregnancy is associated with increased risk of fetal malformations, but withdrawing medication is highly risky for most women with epilepsy or bipolar disorder. Thus, careful clinical monitoring and coordinated care among patient, partner, obstetrician, and psychiatrist are necessary to limit both teratogenetic and neuropsychiatric risks. Several pregnancy registries have appeared. They include the International Registry of Antiepileptic Drugs and Pregnancy (EURAP), the North American Antiepileptic Pregnancy Registry, the International Lamotrigine Pregnancy Registry, the United Kingdom Epilepsy and Pregnancy Register, and the Australian Pregnancy Registry. Data from these registries are helping medical professionals in assessing risks associated with anticonvulsant use during pregnancy and communicating those risks to patients.