Phenytoin in pregnancy: a review of the reported risks.

Over the last 12 years several studies have found that the frequency of certain anomalies in children born to mothers treated with antiepileptic drugs during pregnancy has almost doubled. In 1968 Meadow reported certain malformations that suggest a congenital syndrome involving craniofacial abnormalities and that add to the high level of suspicion pointing to phenytoin. Moreover, multi-drug antiepileptics including phenytoin have been reported to induce carcinogenic damage and coagulation defects. In such instances it is always very difficult to distinguish the individual toxic effects of each component. Nevertheless, the possible role of phenytoin in the development of these diseases must be investigated. In addition, the eventual role of the pathologic state itself, epilepsy, cannot be disregarded. Two main aspects must be considered: the disease and its severity which determines the necessity of high dosages of antiepileptic drugs. The administration of phenytoin to pregnant epileptic patients is clearly questionable. Thus the aim of this paper is to evaluate the risks of this drug and compare them with its expected therapeutic benefits.