Anti-seizure medications (ASM): teratogenicity risks

Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .

Anti-seizure medications (ASM): teratogenicity risks. Valproate: 9.2%, Phenobarbitone: 6%, Topiramate: 5.1%. Fully referenced neurology checklist.

Risk profile

  • Valproate: 9.2%
  • Phenobarbitone: 6%
  • Topiramate: 5.1%
  • Pregabalin: 3.2%
  • Phenytoin: 2.8%
  • Carbamazepine: 2.8%
  • Lamotrigine: 2.1%
  • Levetiracetam: 2.0%
  • Oxcarbazepine: 1.5%
  • Gabapentin: 1.5%
  • Zonisamide: 1.3%
  • Lacosamide: 0%
  • Polytherapy increases the risk: especially if Valproate or Topiramate are involved

Neural tube defects

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Anencephaly

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Cardiac and other organ defects

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Cleft palate

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Foetal death

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References

  1. Hernandez-Diaz S, Quinn M, Conant S, et al. Use of antiseizure medications early in pregnancy and the risk of major malformations in the newborn. Neurology 2025; 105:e213786.
  2. Bromley RL, Weston J, Marson AG. Maternal use of antiepileptic agents during pregnancy and major congenital malformations in children. JAMA 2017; 318:1700-1701. 
  3. Vajda FJE, Graham JE, Hitchcock AA, Lander CM, O'Brien TJ, Eadie MJ. Antiepileptic drugs and foetal malformation: analysis of 20 years of data in a pregnancy register. Seizure 2019; 65:6-11.
  4. Verrotti A, Mencaroni E, Castagnino M, Zaccara G. Foetal safety of old and new antiepileptic drugs. Expert Opin Drug Saf 2015; 14:1563-1571.
  5. Brodie MJ, Kwan P. Current position of phenobarbital in epilepsy and its future. Epilepsia 2012; 53(Suppl 8):40-46.
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