[Effect of anti-epileptic drugs on human placenta and the fetus].

The pregnancy in women with epilepsy is associated with an increased risk of complications and especially with an increased incidence of congenital malformations in offspring. Currently, anti-epileptic drugs (AEDs) are concerned to be a major etiologic factor of abnormal fetal development. The most of AEDs may cross the placenta and reach pharmacologically concentrations in the fetus. Although the pathomechanism of teratogenicity of AEDs is complex and not well understood, a AEDs--dependent folate deficiency is thought as crucial. The reasons may also theoretically include a primary effect of AEDs on placental function and morphology. In the own study on perfused human placental cotyledon, only toxic concentrations of valproic acid caused morphological changes in placental tissue, including microvascular degeneration of cytoplasm, atrophy of syncytiotrophoblast, colliquative necrosis of some mesenchymal cells. The toxic but not therapeutic dose of valproic acid influenced also hormonal function of placenta by lowering of chorionic gonadotrophin concentration in perfusate. Although a knowledge about an influence of AEDs on the placenta and fetus is not complete, the use of these drugs during pregnancy may be more safe. If a dosage of AEDs in pregnant women with epilepsy is reduced to a reasonable minimum and the monotherapy is preferred, the risk of congenital malformations in their offspring can be minimized.