The medical records linkage system of the Rochester Project at the Mayo Clinic was used to identify births at Rochester hospitals from 1922 through 1976 to women with epilepsy and to the wives of men with epilepsy. The children were followed up to determine the incidence of congenital malformation and seizure disorders among them. In 133 births to women before the onset or after the remission of epilepsy, there were no major malformations. Among children born to mothers who had active epilepsy but did not take anticonvulsants during pregnancy, the rate of malformations was not excessive (2/82, or 2.4 per cent). Children of mothers who took anticonvulsants during pregnancy had a high incidence of major congenital malformations (19/177, or 10.7 per cent). Only certain types of malformations were elevated in the offspring of women taking anticonvulsants; these were congenital heart disease, cleft lip or palate, and, perhaps, ureteral duplication. The rate of congenital malformations among the children of men with epilepsy did not appear elevated: 9 in 234 (3.8 per cent) had major malformations. Although a strong association between maternal anticonvulsant medication for epilepsy and certain types of malformations was demonstrated, it is still possible that the association could be due, in part, to the epilepsy per se rather than to the anticonvulsants. The incidence of epilepsy was found to be 3.2 times higher than expected in children of women with epilepsy but was not increased in children of men with epilepsy. This difference does not seem to be due to maternal use of anticonvulsants or seizures during pregnancy.

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