The teratogenic risk of antiepileptic drug polytherapy

Vajda, Fje, Hitchcock, AA, Graham, J, O'Brien, TJ, Lander, CM and Eadie, MJ (2010) The teratogenic risk of antiepileptic drug polytherapy. Epilepsia, 51 5: 805-810. doi:10.1111/j.1528-1167.2009.02336.x

Author Vajda, Fje
Hitchcock, AA
Graham, J
O'Brien, TJ
Lander, CM
Eadie, MJ
Title The teratogenic risk of antiepileptic drug polytherapy
Journal name Epilepsia   Check publisher's open access policy
ISSN 0013-9580
Publication date 2010-05
Year available 2009
Sub-type Article (original research)
DOI 10.1111/j.1528-1167.2009.02336.x
Volume 51
Issue 5
Start page 805
End page 810
Total pages 6
Place of publication Hoboken, NJ, United States
Publisher Wiley-Blackwell Publishing
Collection year 2011
Language eng
Formatted abstract
Purpose: To compare the risks of fetal malformation during pregnancy associated with antiepileptic drug (AED) polytherapy and monotherapy.
Methods: Statistical analysis of malformation rate and antiepileptic drug exposure data from the Australian Register of Antiepileptic Drugs in Pregnancy, and from the literature.
Results: The calculated relative risk (RR) value for AED polytherapy compared with monotherapy was below 1.0 in only 3 of 14 literature publications. In the register, at 1 year postnatally there were fetal malformations in 5.32% of 282 AED polytherapy pregnancies, and in 7.84% of 791 AED monotherapy pregnancies, an RR of 0.68 [95% confidence interval (CI) 0.39-1.17). For pregnancies exposed to valproate, the RR of fetal malformation (0.39, 95% CI 0.20-0.89) was lower in polytherapy (7.26%) than in monotherapy (17.9%); the difference did not depend on valproate dosage. The RR values for fetal malformation were not significantly different for AED polytherapy and monotherapy when valproate was not involved. Logistic regression suggested that coadministration of lamotrigine may have reduced the malformation risk from valproate.
Discussion: The fetal hazard of AED polytherapy relative to monotherapy may depend more on the degree of exposure to valproate than on the fact of polytherapy per se. Coadministration with lamotrigine may lower the fetal risk of valproate therapy.
© 2009 International League Against Epilepsy.
Keyword Antiepileptic drugs
Fetal malformations
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 8 October 2009

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 32 times in Thomson Reuters Web of Science Article | Citations
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Created: Sun, 09 May 2010, 00:04:26 EST