Prediction of the hazard of foetal malformation in pregnant women with epilepsy

• Predictive tool to help assess the risk of foetal malformations.
• Prospective data collected by the Australian Pregnancy Register.
• Risks, lower income, primary generalised epilepsy, valproate, previous defects.
• High valproate dose relates to increased risk.
• Possibility of protective effect of alcohol – needs validation.

SummaryThe data collected in the Australian Register of antiepileptic drugs in pregnancy have been studied in the hope of defining simple items of information that could be recorded at initial interview of pregnant women with epilepsy, and which might allow estimation of the risk of the pregnancy resulting in a malformed foetus. Analysis of the data showed that dose of valproate, but not intake of other commonly used antiepileptic drugs, in the current pregnancy, and a past history of a pregnancy involving a malformed foetus, statistically significantly increased the malformation hazard in the current pregnancy, and that continuing alcohol intake might decrease it. Plotting the hazard against valproate dose in monotherapy, with or without histories of (i) previous pregnancies with foetal malformations (FMs), and (ii) continuing alcohol intake, provided quantitative information concerning the degree of increased risk. It is hoped that this information may help in advising about the risk of foetal malformation (FM) in individual pregnancies.