Anti‐epileptic drug exposure and risk of foetal death in utero
The Viale et al2 paper did not include the recent large study of Tomson et al3 that was based on 7055 pregnancies from the EURAP Pregnancy Register. That study found very similar rates of intrauterine foetal death (spontaneous abortion plus stillbirth) for women taking various more commonly employed AEDs (lamotrigine, carbamazepine, valproate, levetiracetam, oxcarbazepine, phenobarbitone) and no correlations with AED dosage. Unfortunately, this study did not include a control group of pregnant women with epilepsy that was not treated with an AED. In contrast to the Vaile et al2 study, AED polytherapy in the Tomson et al study was found to be associated with a statistically significantly higher rate of intrauterine foetal death.
As the findings of these two studies differed in some regards, we have utilized data from the Australian Register of AEDs in Pregnancy (APR) to investigate the association of AED use during pregnancy with intrauterine foetal deaths. The APR contains a subset of pregnancies unexposed to AEDs, in at least the earlier half of pregnancy, in women with epilepsy, and this subset can provide a comparator for the Register's AED‐exposed pregnancies. Data from this work have also been provided for the EURAP data set in collaboration with the International Register, chaired by T. Tomson.