Abstract
Introduction
The potential for prenatal exposure to antiseizure medications to increase the risk of congenital malformations has been a concern for decades. This study fills an information gap regarding congenital malformations and related factors in the offspring of mothers with epilepsy in Poland.
Materials and methods
The study uses prospectively collected data from an institutional database of a tertiary epilepsy centre between 2000 and 2024, including data from 1,467 pregnancies (mean maternal age = 29.02).
Results
These pregnancies resulted in live births (83.9%), miscarriages (15.4%), and perinatal deaths (0.7%). Major congenital malformations (MCM), identified at birth, were observed in 6.4% of children, most commonly affecting the cardiovascular system (33.0%), urogenital system (21.3%), and involving multiple defects (13.8%). Mothers of children with MCM were older than those of children without MCM, p = 0.026. No statistically significant associations were found between the occurrence of MCMs and the type of epilepsy, folic acid intake prior pregnancy, seizures in the first trimester, type of treatment (mono-vs polytherapy), or treatment versus no treatment. Among all medications, only valproate use was associated with a higher risk of MCM – 30.9% versus 20.5%, χ2 = 5.60, p = 0.026, ϕ = 0.06.
Conclusions
The use of valproate by women with epilepsy during pregnancy increases the risk of birth defects in the child. These findings support efforts to reduce VPA use during pregnancy and to encourage pregnancy planning. Mothers of children with major congenital malformations were statistically older – a weak but potentially clinically significant risk factor. Aside from maternal age, no other analysed factors were linked to a higher risk of malformations.