Risk factors for complications:
(1) prescription by a practitioner unaware of the teratogenic risks
(2) high doses (effect dose dependent)
(3) therapy during the first trimester of pregnancy
(4) folic acid deficiency
Complications may include:
(1) neural tube defects with central nervous system malformations
(2) high forehead with bifrontal narrowing
(3) epicanthal folds
(4) broad or depressed nasal bridge
(5) long and shallow philtrum
(6) upturned nose
(7) small downturned mouth with thin upper lip
(8) cleft palate
(9) low set ears
(10) coarctation of the aorta
(11) hypoplastic left heart
(12) atrial or ventricular septal defect
(13) stenosis of the aortic valve
(14) pulmonary atresia
(15) hypospadias (in males)
(16) broad hands and feet
(17) long, thin fingers and toes
(18) hyperconvex nails
(19) developmental motor delay
(20) mental retardation
Differential diagnosis:
(1) exposure to other anticonvulsants during pregnancy
(2) exposure to other teratogens during pregnancy
