Teratogenicity; updated North American Registry

As healthcare practitioners who primarily see problems in the human brain, it is incumbent on us to ensure that foetuses' brains are protected as best as humanly possible, especially from iatrogenic harm. The above database has been updated in a newly published article in Neurology. You can find the study here, but you will need institutional access or a subscription. 

Use of Antiseizure Medications Early in Pregnancy and the Risk of Major Malformations in the Newborn | Neurology

Here is a useful visual representation of the findings of the registry. The red dots are the point estimates, but it is best to focus on the 95% confidence intervals.

The American Epilepsy Society have just updated their guidelines regarding pregnancy, and the publication can be found here Teratogenesis, Perinatal, and Neurodevelopmental Outcomes After In Utero Exposure to Antiseizure Medication | Neurology. Some concerns have been raised about the use of higher doses of folic acid in pregnancy and it would seem prudent to limit this to approximately 1 mg per day for women of childbearing potential and those who are pregnant. Lamotrigine, levetiracetam and oxcarbazepine are the treatments of choice for mothers of childbearing potential, but as always one must weigh benefits and risks. Any benefits of switching medications may be eroded by the emergence of generalized tonic-clonic seizures. As you probably know, these discussions should be had long in advance of any planned pregnancy, let alone unplanned ones. I typically initiate these discussions in the mid teenage years. There is not enough data about lacosamide (the confidence intervals are too wide), but the range is starting to look favourable. Time will tell.