Use Of Antiepileptic Medications During Pregnancy And The Potential Impact On Birth Defects

Doctor discussing medication with a pregnant woman

A special issue of the American Journal of Medical Genetics Part C with a specific focus on teratology included the CDC study: “Influencing Clinical Practice Regarding the Use of Antiepileptic Medications During Pregnancy: Modeling the Potential Impact on the Prevalences of Spina Bifida and Cleft Palate in the United States.”

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Main Findings

  • About 40 infants with spina bifida and about 35 infants with cleft palate could be born without these defects each year in the United States if valproic acid were not used during pregnancy.
  • About 5 infants with spina bifida and about 5 infants with cleft palate could be born without these defects each year in the United States if carbamazepine were not used during pregnancy.

This study demonstrates the potential public health impact if doctors were to switch women of childbearing age who need treatment with certain antiepileptic medications to lower risk medications when possible.

About This Study

Emerging Issues in Teratology

An introductory editorial article co-written by a CDC author is also in the special issue of this journal. This article gives a brief historical overview of the study of birth defects. It also highlights emerging topics that are discussed in the special issue.

Epilepsy is a disorder in which individuals have repeated seizures. Epilepsy, and sometimes other diseases such as chronic headaches and bipolar disorder, can be treated with antiepileptic medications, such as valproic acid and carbamazepine. Pregnant women need treatment for epilepsy because it is possible that seizures can cause adverse health outcomes for the mother and her developing baby. However, previous studies consistently have found that babies born to women who take certain antiepileptic medications during pregnancy have an increased risk for birth defects.

Studies have shown that valproic acid presents the most risk to the developing baby. Along with valproic acid, carbamazepine might increase the risk for spina bifida (a major birth defect of the baby’s spine) and cleft palate (a birth defect of the baby’s mouth).

For this study, researchers estimated how many babies could be born each year without spina bifida and cleft palate if all women who needed treatment with valproic acid or carbamazepine were switched to lower risk medications during pregnancy. Prevention of even a few major birth defects could have a major public health impact, given the disabilities and costs associated with birth defects. 1-5

Our Work

Treating for Two Safer Medication Use in Pregnancy logo

CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) is working to improve the health of women and babies through its Treating for Two: Safer Medication Use in Pregnancy initiative. Treating for Two works to understand trends in medicine among pregnant women and women of reproductive age, and provide women and healthcare providers with information about the safety or risk of using specific medicines during pregnancy. This information will allow women and their doctors to make informed decisions about treating health conditions during pregnancy.

For more information, visit www.cdc.gov/treatingfortwo.

References
  1. CDC. Hospital stays, hospital charges, and in-hospital deaths among infants with selected birth defects, United States, 2003. MMWR 2007;56:25-29.
  2. Ouyang L, Grosse SD, Armour BS, Waitzman NJ. Health care expenditures of children and adults with spina bifida in a privately insured U.S. population. Birth Defects Res A Clin Mol Teratol. 2007;79:552-8.
  3. Cassell CH, Meyer R, Daniels J. Health care expenditures among Medicaid enrolled children with and without orofacial clefts in North Carolina, 1995-2002. Birth Defects Res A Clin Mol Teratol. 2008;82:785–94.
  4. Weiss J, Kotelchuck M, Grosse S, Manning SE, Anderka M, Wyszynski DF. Hospital use and associated costs of children ages zero-to-two years with craniofacial malformations in Massachusetts. Birth Defects Res A Clin Mol Teratol. 2009;85:925–34.
  5. Boulet SL, Grosse SD, Honein MA, Correa-Villaseñor, A. Children with orofacial clefts: health care use and costs among a privately insured population. Public Health Rep. 2009;124:447–53.
Reference for Key Findings Summary

Gilboa SM, Broussard CS, Devine OJ, Duwe KN, Flak AL, Boulet SL, Moore CA, Werler MM, and Honein MA. Influencing Clinical Practice Regarding the Use of Antiepileptic Medications During Pregnancy: Modeling the Potential Impact on the Prevalences of Spina Bifida and Cleft Palate in the United States. Am J Med Genet Part C. 2011; 157:234-246.