What is the potential fetal risk associated with using topiramate during pregnancy?

Topiramate, an anticonvulsant medication, has been associated with an increased risk of both cleft lip and cleft palate when used during pregnancy. This association is particularly significant during the first trimester, a critical period for fetal development when organs and structures are forming. The risk stems from topiramate's mechanism of action, which can interfere with certain metabolic pathways that are essential for proper embryonic development.

Research has shown that the use of topiramate in pregnant individuals is linked to these congenital malformations, and clinicians often weigh the benefits of seizure control against the potential for these risks when considering this medication for pregnant patients. This focus on cleft lip and palate is critical given that these conditions can have both physical and psychosocial implications for affected individuals.

While other options mention concerns such as neural tube defects, fetal heart irregularities, and low birth weight, the strongest evidence in literature connects topiramate with clefting issues, making this the most relevant fetal risk associated with its use during pregnancy.