FINDINGS IN CHILDREN EXPOSED IN-UTERO TO PHENYTOIN AND CARBAMAZEPINE MONOTHERAPY - INDEPENDENT EFFECTS OF EPILEPSY AND MEDICATIONS

Our objective was to evaluate the patterns of malformations in childre n exposed in utero to phenytoin (DPH) and carbamazepine (CBZ) monother apy, and to compare them prospectively with matched mother-child pairs exposed to nonteratogens, and to separate the effects of antiepilepti c drugs (AEDs) from those of epilepsy by collecting groups of untreate d epileptics and those treated with DPH and CBZ for conditions other t han epilepsy, This was a prospective, controlled, and blinded observat ional study. Thirty-six mother-child pairs exposed to CBZ monotherapy, 34 pairs exposed to DPH monotherapy, and 9 nonmedicated epileptic wom en and their children were compared with matched mother-child pairs ex posed to nonteratogens, The control mothers were matched for maternal age, time of consultation, obstetric history, and socioeconomic status (SES), One main outcome measures a ''blinded'' morphological assessme nt of the offspring. We found that minor anomalies were significantly more common among children of epileptics on either drug (P = 0.01) and among DPH-treated nonepileptic offspring (P = 0.03), Among epileptics , the relative risk for minor anomalies following DPH (2.1) was simila r to that after exposure to either DPH (P = 0.006) or CBZ (P = 0.01). Increased rates of hypertelorism were detected among DPH-exposed offsp ring, High forehead, frontal bossing, malar hypoplasia, epicanthus and micrognathia were associated with untreated epilepsy, as well as with DPH and CBZ treatment. (C) 1997 Wiley-Liss, Inc.