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

Helen Dolk, Janneke Jentink, Maria Loane, Joan Morris, Lolkje TW de Jong-van den Berg, Antiepileptic Drug Working Group EUROCAT

Research output: Contribution to journalArticle

103 Citations (Scopus)

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
LanguageEnglish
Pages714-722
JournalNeurology
Volume71
DOIs
Publication statusPublished - 2008

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Cleft Palate
Pregnancy
Anticonvulsants
First Pregnancy Trimester
Stillbirth
lamotrigine
Maternal Age
Neurology
Prenatal Diagnosis
Pharmaceutical Preparations
Population
Registries
Case-Control Studies
Parturition

Cite this

Dolk, Helen ; Jentink, Janneke ; Loane, Maria ; Morris, Joan ; de Jong-van den Berg, Lolkje TW ; EUROCAT, Antiepileptic Drug Working Group. / Does lamotrigine use in pregnancy increase orofacial cleft risk relative to other malformations?. In: Neurology. 2008 ; Vol. 71. pp. 714-722.
@article{7e843c91a7f3456381918251f05028d6,
title = "Does lamotrigine use in pregnancy increase orofacial cleft risk relative to other malformations?",
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{\circledR} 2008;71:714–722",
author = "Helen Dolk and Janneke Jentink and Maria Loane and Joan Morris and {de Jong-van den Berg}, {Lolkje TW} and EUROCAT, {Antiepileptic Drug Working Group}",
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Does lamotrigine use in pregnancy increase orofacial cleft risk relative to other malformations? / Dolk, Helen; Jentink, Janneke; Loane, Maria; Morris, Joan; de Jong-van den Berg, Lolkje TW; EUROCAT, Antiepileptic Drug Working Group.

In: Neurology, Vol. 71, 2008, p. 714-722.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Does lamotrigine use in pregnancy increase orofacial cleft risk relative to other malformations?

AU - Dolk, Helen

AU - Jentink, Janneke

AU - Loane, Maria

AU - Morris, Joan

AU - de Jong-van den Berg, Lolkje TW

AU - EUROCAT, Antiepileptic Drug Working Group

PY - 2008

Y1 - 2008

N2 - 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

AB - 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

U2 - 10.1212/01.wnl.0000316194.98475.d8

DO - 10.1212/01.wnl.0000316194.98475.d8

M3 - Article

VL - 71

SP - 714

EP - 722

JO - BMC Neurology

T2 - BMC Neurology

JF - BMC Neurology

SN - 0028-3878

ER -