Pregnancy outcomes in women with epilepsy: A systematic review and meta-analysis of published pregnancy registries and cohorts
Open accessAbstract
Purpose To conduct a systematic review and meta-analysis to quantify the incidence of congenital malformations (CMs) and other pregnancy outcomes as a function of in utero anti-epileptic drug (AED) exposure.Methods We performed a systematic literature review to identify all published registries and cohort studies of births from pregnant women with epilepsy (WWE) that reported incidence of CMs. Overall incidences were calculated using a random effects model.Results The review included 59 studies that met inclusion/exclusion criteria, involving 65,533 pregnancies in WWE and 1,817,024 in healthy women. The calculated incidence of births with CM in WWE [7.08%; 95% CIs 5.62, 8.54] was higher than healthy women [2.28%; CIs 1.46, 3.10]. Incidence was highest for AED polytherapy [16.78%; CIs 0.51, 33.05]. The AED with the highest CM incidence was valproate, which was 10.73% [CIs 8.16, 13.29] for valproate monotherapy.Conclusions Results of this systematic literature review suggest that the overall incidence of CMs in children born of WWE is approximately threefold that of healthy women. The risk is elevated for all AED monotherapy and further elevated for AED polytherapy compared to women without epilepsy. The risk was significantly higher for children exposed to valproate monotherapy and to polytherapy of 2 or more drugs when the polytherapy combination included phenobarital, phenytoin, or valproate. Further research is needed to delineate the specific risk for each individual AED and to determine underlying mechanisms including genetic risk factors.
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AED use during pregnancy is associated with adverse neurodevelopment outcomes in children.
“AED use during pregnancy is associated with risks to the fetus as these drugs can cross the placenta or may be transferred to the infant through breast feeding and may be associated with adverse neurodevelopment outcomes.2–4”
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Flagged first, then by citations
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Cognitive Function at 3 Years of Age after Fetal Exposure to Antiepileptic Drugs
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Self-citationBipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period
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Antiepileptic drugs in women with epilepsy during pregnancy
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Self-citation
- Authors
- Meador, K., Reynolds, M. W., Crean, S., Fahrbach, K., & Probst, C.
- Affiliations
- University of Florida Health (US)
- Corresponding author
- Meador, Kimford
- Venue
- Epilepsy Research
- Publisher
- Elsevier BV
- Published
- 2008-09
- Volume
- 81
- Issue
- 1
- Pages
- 1-13
- ISSN
- 0920-1211 (ISSN-L)
- PMC
- PMC2660205
- OpenAlex
- W2076472832
- Cited by
- 400
- References
- 103
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 13 · 2023: 19 · 2022: 20 · 2021: 21 · 2020: 23 · 2019: 28 · 2018: 23 · 2017: 32 · 2016: 26 · 2015: 32 · 2014: 26 · 2013: 31 · 2012: 28
- FWCI
- 2.68
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Epilepsy Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (R01NS038455)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Keywords
- pregnancy outcomes, women with epilepsy, congenital malformations, antiepileptic drugs, valproic acid, prenatal drug exposure, phenobarbital, phenytoin, birth defects risk
- MeSH terms
- Abnormalities, Drug-Induced, Adult, Anticonvulsants, Data Interpretation, Statistical, Drug Therapy, Combination, Epilepsy, Female, Humans, Infant, Newborn, Male, Pregnancy, Pregnancy Complications, Registries, Risk Factors, Cohort Studies, Databases, Factual, MEDLINE
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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