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Does lamotrigine use in pregnancy increase orofacial cleft risk relative to other malformations?

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Dolk, Helen, Jentink, Janneke, Loane, Maria, Morris, Joan, de Jong-van den Berg, Lolkje TW and EUROCAT, Antiepileptic Drug Working Group (2008) Does lamotrigine use in pregnancy increase orofacial cleft risk relative to other malformations? Neurology, 71 . pp. 714-722. [Journal article]

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URL: http://www.neurology.org/cgi/content/full/71/10/714

DOI: 10.1212/01.wnl.0000316194.98475.d8server

Abstract

Objective: To investigate whether first trimester exposure to lamotrigine (LTG) monotherapy is specifically associated with an increased risk of orofacial clefts (OCs) relative to other malformations, in response to a signal regarding increased OC risk.Methods: Population-based case-control study with malformed controls based on EUROCAT congenital anomaly registers. The study population covered 3.9 million births from 19 registries 1995–2005. Registrations included congenital anomaly among livebirths, stillbirths, and terminations of pregnancy following prenatal diagnosis. Cases were 5,511 nonsyndromic OC registrations, of whom 4,571 were isolated, 1,969 were cleft palate (CP), and 1,532 were isolated CP. Controls were 80,052 nonchromosomal, non-OC registrations. We compared first trimester LTG and antiepileptic drug (AED) use vs nonepileptic non-AED use, for mono and polytherapy, adjusting for maternal age. An additional exploratory analysis compared the observed and expected distribution of malformation types associated with LTG use.Results: There were 72 LTG exposed (40 mono- and 32 polytherapy) registrations. The ORs for LTG monotherapy vs no AED use were 0.67 (95% CI 0.10–2.34) for OC relative to other malformations, 0.80 (95% CI 0.11–2.85) for isolated OC, 0.79 (95% CI 0.03–4.35) for CP, and 1.01 (95% CI 0.03–5.57) for isolated CP. ORs for any AED use vs no AED use were 1.43 (95% CI 1.03–1.93) for OC, 1.21 (95% CI 0.82–1.72) for isolated OC, 2.37 (95% CI 1.54–3.43) for CP, and 1.86 (95% CI 1.07–2.94) for isolated CP. The distribution of other nonchromosomal malformation types with LTG exposure was similar to non-AED exposed.Conclusion: We find no evidence of a specific increased risk of isolated orofacial clefts relative to other malformations due to lamotrigine (LTG) monotherapy. Our study is not designed to assess whether there is a generalized increased risk of malformations with LTG exposure.Neurology® 2008;71:714–722

Item Type:Journal article
Faculties and Schools:Faculty of Life and Health Sciences
Faculty of Life and Health Sciences > School of Nursing
Research Institutes and Groups:Institute of Nursing and Health Research
Institute of Nursing and Health Research > Maternal, Fetal and Infant Research
ID Code:6738
Deposited By:Ms Maria Loane
Deposited On:02 Feb 2010 16:41
Last Modified:21 Nov 2012 15:32

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