Fetal Anticonvulsant Syndrome (FACS), also known as fetal valproate syndrome and fetal hydantoin syndrome, is a group of malformations that can affect some babies if they are exposed to certain medicines known as antiepileptic drugs (AEDs) while in the womb. Most women with epilepsy will have a healthy child. However, for pregnant women with epilepsy who are taking antiepileptic medications, there are risks associated with the baby’s development.
Here are some key points about Fetal Anticonvulsant Syndrome:
The Risk Factors:
- The risk of FACS depends on the type, number, and dose of the antiepilepsy medication.
- Commonly known antiepileptic drugs associated with FACS include:
- Carbamazepine
- Phenytoin
- Primidone
- Phenobarbital
- Lamotrigine
- Levetiracetam
- Among these, sodium valproate is thought to have the largest risk. There is less data available on the effects of Lamotrigineand Levetiracetam, due to fewer women taking these medications.
The Risk Levels:
- For women not taking antiepileptic drugs, the chance of the baby having a major problem (such as FACS) is similar to women without epilepsy.
- For women taking AEDs, the risk depends on the medication:
- The risk for any one drug is about 6 out of 100(double the background level of risk).
- The risk increases with the number of drugs taken.
- Babies of women taking two or more AEDs have a 10-14 out of 100risk of being born with a problem.
- For those taking a combination of valproate, carbamazepine, and phenytoin, the risk can be as high as 50 out of 100.
Why we specialise in this area?
Our Director, Gilly Daniels, has first hand experience in this sector.
“Having suffered with Epilepsy since 2001 my seizures were intermittently uncontrolled for a period of around 15 years. The only medication that controlled my seizures was Epilim (Sodium Valproate). Over the years I had tried many different drugs including Lamotrigine and Keppra.
In 2014 I became pregnant with my first child. My husband and I were informed of some of the congenital defects that could arise from Epilim during pregnancy, mainly life changing disabilities including Spina Bifida were touched on during my consultations, but we were reassured that subject to the NTD scan retuning normal results, then I could continue my pregnancy whilst taking Epilim.
Even in 2015, at no point were we informed of the exhaustive list of issues that AED’s in pregnancy could cause. I remained on Epilim for the first twenty weeks of my pregnancy, until we experienced restricted growth. At this point in time my Epilim was immediately withdrawn and we attended weekly growth scans.
Our first child has suffered some health complications in his early years, which we hope have now been resolved through surgery however we will not know the long term implications of these until he is much older.
Our first child took part in the NAME study, conducted between 2015 and 2018, led by Dr Rebecca Bromley, a study to analyse the effect of AED’s during pregnancy. As part of this study, our child underwent neurodevelopmental studies during the first two years of his life and thankfully, he met all of the developmental benchmarks.
Upon publication of Henrietta Hughes Report in early 2024, the physical, learning, and developmental complications listed in this report were much more extensive than had ever been communicated to my husband and I, despite there being knowledge of this pre 2014.
Not long after my pregnancy, I received written communication from the NHS advising that I would not be permitted to go back onto Sodium Valproate due to being in a “childbearing age bracket”.
At this point in time, I considered this a cautionary preventative measure, I still had no idea the extent of research that had already taken place and the risks that had already been identified and not communicated by medical professionals.
I understand first hand the torment and guilt that mothers have endured in trying to assess and balance the risks of the harm a seizure during pregnancy could cause versus the risk of taking medications during pregnancy. Further, many mothers feel they have been misinformed of the actual risks of this medication and the publications of the reports have frequently referred to this as a “scandal” and as severe as “Thalidomide”
I always have, and always will have, a keen interest in this topic as well as the ability to understand what victims have been through. I liaise with INFACT and Emma Murphy, INFACT Co-Founder, who has campaigned for over 30 years on this topic.”