Petersen I, et al. – The clinicians investigated the prevalence of major congenital malformations associated with antiepileptic drug (AED) treatment in pregnancy. They suggested that compared to valproate, lamotrigine and carbamazepine were safer treatment options in pregnancy and ought to be considered as alternative treatment options for women of childbearing potential and in pregnancy.

• The clinicians identified women who have given live birth and their offspring using data from The Health Improvement Network.
• They selected 4 subgroups based on the AED treatment in early pregnancy, valproate, carbamazepine, lamotrigine and women not receiving AED treatment.
• The prevalence of major congenital malformations within children of these 4 groups were compared.
• They estimated prevalence ratios (PRs) using Poisson regression adjusted for maternal age, sex of the child, quintiles of Townsend deprivation score and indication for treatment.

• The clinicians included 240,071 women in the study.
• They prescribed valproate to 229 women in pregnancy, 357 were prescribed lamotrigine and 334 were prescribed carbamazepine and 239,151 women were not prescribed AEDs.
• 15/229 (6.6%) women prescribed valproate gave birth to a child with a major congenital malformation.
• 2.7%, 3.3%, and 2.2% were the figures for lamotrigine, carbamazepine and women not prescribed AEDs, respectively.
• Compared to women with no AED treatment in pregnancy, the prevalence of major congenital malformation was similar for women prescribed lamotrigine or carbamazepine.
• The prevalence was fourfold higher for women prescribed valproate in polytherapy.
• The effect of estimates attenuated after adjustments, but the prevalence remained two- to threefold higher in women prescribed valproate.