What are the fetal risks of carbamazepine during pregnancy?

Updated: Aug 20, 2019
  • Author: Carmel Armon, MD, MSc, MHS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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A review of all published cohort studies yielded an overall prevalence of 3.3% for a major congenital malformation after exposure to carbamazepine monotherapy during the first trimester of pregnancy. [25]

Spina bifida was the only major congenital malformation associated with carbamazepine as compared with no AED. The risk was smaller with carbamazepine than with valproate. However, the risk of spina bifida with carbamazepine was no different from that with other nonvalproate AEDs. [25]

The risk of fetal hypospadias with mothers taking carbamazepine was comparable to that with mothers taking other nonvalproate AEDs and lower than that with mothers taking valproate. The risk of cleft lip, with or without cleft palate, was lower for carbamazepine monotherapy than for other nonvalproate AED monotherapy (phenobarbital in more than 50% of cases) or for valproate (though the difference in this case was statistically nonsignificant).

Overall, therefore, the risks of carbamazepine to the fetus are smaller than those of valproate and comparable to those of other nonvalproate AEDs, except for the lower risk of cleft lip, with or without cleft palate, on carbamazepine.

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