Spina Bifida Is Only Major Risk to Fetus From Carbamazepine

But this risk is lower than spina bifida risk from valproic acid use in first trimester

FRIDAY, Dec. 3 (HealthDay News) -- Spina bifida is the only major congenital malformation significantly associated with exposure to carbamazepine monotherapy, and this risk is much lower than the risk of spina bifida associated with use of valproic acid, according to research published Dec. 2 in BMJ.

To identify specific congenital malformations associated with use of carbamazepine in the first trimester of pregnancy, Janneke Jentink, of the University of Groningen in the Netherlands, and colleagues conducted a literature review of eight cohort studies comprising 2,680 pregnancies with carbamazepine monotherapy exposure.

Overall, the researchers found a 3.3 percent prevalence of major congenital malformation after carbamazepine monotherapy exposure in the first trimester. The only major congenital malformation significantly associated with exposure to carbamazepine was spina bifida (odds ratio, 2.6 compared to no antiepileptic drug exposure), but this risk was lower for carbamazepine compared to valproic acid (odds ratio, 0.2).

"We agree with the recent recommendation of the American Academy of Neurology to avoid valproic acid in pregnancy if possible. Our literature review gives a 3.3 percent risk of major malformations with carbamazepine monotherapy, and our case-control study shows that the major concern is a moderately increased risk of spina bifida," the authors write.

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