Editing Phenytoin (section)

===Pregnancy===
Phenytoin is a known [[teratogenesis|teratogen]], since children exposed to phenytoin are at a higher risk of [[birth defects]] than children born to women without epilepsy and to women with untreated epilepsy.<ref name="Bromley_2014">{{cite journal | vauthors = Bromley R, Weston J, Adab N, Greenhalgh J, Sanniti A, McKay AJ, Tudur Smith C, Marson AG | title = Treatment for epilepsy in pregnancy: neurodevelopmental outcomes in the child | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 10 | pages = CD010236 | date = October 2014 | pmid = 25354543 | pmc = 7390020 | doi = 10.1002/14651858.CD010236.pub2 | collaboration = Cochrane Epilepsy Group }}</ref><ref name="Bromley_2023">{{cite journal | vauthors = Bromley R, Adab N, Bluett-Duncan M, Clayton-Smith J, Christensen J, Edwards K, Greenhalgh J, Hill RA, Jackson CF, Khanom S, McGinty RN, Tudur Smith C, Pulman J, Marson AG | title = Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 8 | pages = CD010224 | date = August 2023 | pmid = 37647086 | pmc = 10463554 | doi = 10.1002/14651858.CD010224.pub3 }}</ref> The birth defects, which occur in approximately 6% of exposed children, include [[neural tube defect]]s, [[Congenital heart defect|heart defects]] and [[Craniofacial abnormality|craniofacial abnormalities]], including broad nasal bridge, cleft lip and palate, and [[Microcephaly|smaller than normal head]].<ref name="Bromley_2023" /><ref>{{cite book |title=Obstetrics and Gynecology |vauthors=Beckmann CR |publisher=Lippincott Williams & Wilkins |year=2002 |edition=4th |location=Baltimore |display-authors=etal}}</ref> The effect on IQ cannot be determined as no study involves phenytoin as monotherapy, however poorer language abilities and [[delayed motor development]] may have been associated with maternal use of phenytoin during pregnancy.<ref name="Bromley_2014" /> This syndrome resembles the well-described [[Fetal Alcohol Syndrome|fetal alcohol syndrome]].<ref>{{cite web | vauthors = ((National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect)) | title = Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis | date = July 2004 | url = https://www.cdc.gov/ncbddd/fasd/documents/fas_guidelines_accessible.pdf | work = National Center on Birth Defects and Developmental Disabilities | publisher = Centers for Disease Control and Prevention; U.S. Department of Health and Human Services }}</ref> and has been referred to as "[[fetal hydantoin syndrome]]". Some recommend avoiding polytherapy and maintaining the minimal dose possible during pregnancy, but acknowledge that current data fails to demonstrate a dose effect on the risk of birth defects.<ref name="Bromley_2014" /><ref name="Bromley_2023" /> Data now being collected by the Epilepsy and Antiepileptic Drug Pregnancy Registry may one day answer this question definitively.