Adverse effects associated with maternal carbamazepine therapy:
(1) neural tube defects with spina bifida and lumbar meningomyeloceles
(2) craniofacial defects including cleft palate
(3) hemorrhagic disease of the newborn associated with reduced vitamin K levels
The reported rate of adverse effects range from 2.2 to 6.5% but many cases have more than one risk factor. In addition, women taking antiepileptic drugs may have a low serum folate level that is easily corrected by supplemental doses of folic acid.
The risk of adverse effects with carbamazepine can be reduced by:
(1) administer folic acid during the pregnancy
(2) use the lowest effective dose
(3) use monotherapy if at all possible
(4) evaluate the neonate soon after birth, providing vitamin K if needed
