The safest antiepileptic drugs in pregnancy

Recently published in JAMA Neurology, a longitudinal cohort study showed that offspring of women with epilepsy exposed to levetiracetam, oxcarbazepine, and lamotrigine had the lowest prevalence of major congenital malformations (MCMs) compared with other antiseizure medications (ASMs). These findings may help guide clinicians for safer treatment selection in women of childbearing who potentially require the use of ASM therapy.

Among 10,121 prospective pregnancies exposed to ASM monotherapy, 9840 pregnancies in 8483 women (mean age in years, 30.1; range, 14.1-55.2) were exposed to 8 of the most frequently used ASMs.

Levetiracetam, oxcarbazepine, and lamotrigine showed the lowest prevalence of major congenital malformations compared with other antiseizure medications. Authors noted a significant increase in the prevalence of MCMs associated with increasing dose for valproate, phenobarbital, and carbamazepine among the participants.