ABSTRACT
Understanding the association between exposure to antiepileptic medications during
pregnancy and the diverse manifestations of adverse outcome is complicated by the need to
first understand basic principles of teratogenic, and particularly neuro-teratogenic, action
and basic definitions of adverse outcomes. Conveyance of information specific to the
teratogenicity of anticonvulsants is further complicated by the fact that the emergence in the
late 1960s of studies raising concern about antiepileptic drug use during pregnancy
overlapped with the establishment of the basic scientific principles. As a result, the designs
of early studies pre-dated recognition of certain principles of teratogenic action as well
as recognition of the need to employ certain design characteristics when neurodevelop-
mental, especially cognitive, endpoints were examined. In light of these complexities
and with the goal of having this chapter serve the needs not only of neurobehavioral
teratologists, but of students, health professionals, regulatory scientists, and structurally-
focused teratologists, our approach is to cover certain fundamentals alongside the data
specific to the actions of anticonvulsant medications as neurobehavioral teratogens.
Thus, we will first examine fundamentals of teratogenic action and the nature of adverse
outcomes, and then focus on the risks associated with anticonvulsant exposure during
pregnancy. By necessity, opening discussions are brief and make considerable reference to
review sources.
