Phenytoin teratogenicity and effects on embryonic and maternal folate metabolism

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Abstract
It has been postulated that the mechanism of teratogenicity of the anticonvulsant drug phenytoin (PHT), is via a deficiency of folic acid. To test this hypothesis, Swiss Webster mice were administered PHT in the diet prior to and throughout gestation. Animals received a daily dose of approximately 75 mg/kg body weight. The maternal plasma PHT levels were within the therapeutic range for this drug. This dose increased the incidence of malformations, primarily cleft palate, in the absence of embryolethality. There was a decrease in maternal plasma folate levels on day 12 of gestation but no effect on days 10 and 18. Even in the presence of a maternal folate deficiency on day 12, PHT had no effect on total embryonic folate levels on days 10, 12, and 14. Previous experiments have demonstrated that PHT decreases activity of the enzyme 5, 10-methylenetetrahydrofolate reductase in the liver of non-pregnant Swiss Webster mice. Data from the current study indicate that this enzyme activity is also decreased in hepatic tissue of pregnant mice, but it is not altered in embryos on the days examined. These data show that a teratogenic dose of PHT affects maternal folate metabolism. However embryonic folate metabolism, when measured in total embryos, was not affected.