In utero exposure to first-generation antiepileptic drugs (AEDs) has been shown to increase the risk of congenital malformations and cognitive deficits (1). The risk of major congenital malformations with AED exposure is estimated to be between 4 and 9 percent, compared with the background risk of 1 to 2 percent (2). Prenatal exposure to different older-generation AEDs has been associated with different malformations. For example, the risk of spina bifida increases with exposure to valproate, digit hypoplasia with phenytoin, oral clefts with phenobarbital, and neural tube defects with carbamazepine (3). Moreover, recent data have suggested that fetal exposure to valproate can increase the risk of autism (4) and can affect the child's cognitive abilities (1). However, until recently, data on the safety of newer-generation AEDs have been limited, except for lamotrigine (5).
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