Fetal phenytoin exposure , hypoplastic nails , and itteriness

In a prospective study infants born to mothers with epilepsy (n=61) were found to have an unexpectedly high incidence of congenital anomalies (26/61, 43%) and neonatal conditions (26/61, 43%) compared with controls (0/62, and 6/62, 10%, respectively). There were two neonatal deaths in the study group but none among the controls. Hypoplasia of the finger or toenails was a common congenital anomaly in those infants whose mothers had received phenytoin alone or in combination with other anticonvulsant drugs (11 of 40, 28%). The mean serum phenytoin concentration was higher among mothers of infants with hypoplastic nails than among those with normal nails. Jitteriness was a common neonatal condition affecting infants of epileptic mothers (11 of 61, 18%) but not controls. The mean cord serum phenytoin concentrations were similar among jittery and nonjittery infants. At follow up (after excluding one infant with Down's syndrome from the study group) the infants seemed to have developed normally, though one had serious learning difficulties at school. We suggest that hypoplasia of the nails is related to high maternal serum concentrations of phenytoin, and though 18% of infants born to epileptic mothers were jittery compared with no control infants this may not be the result of withdrawal of the drug in all cases. tal anomalies and neonatal conditions in infants born to epileptic mothers were compared with those in a control group born to mothers without epilepsy. Hypoplasia of the finger and toenails and jitteriness, which were commonly seen in infants of epileptic mothers, were related to phenytoin concentrations in maternal blood and cord blood, respectively. Infants of epileptic mothers and of controls were followed up at