Valproate poses risk to unborn child.

Abstract

The Longer Term Outcome of Children Born to Mothers with Epilepsy Adab N, Kini U, Vinten J, Ayres J, Baker G, Clayton-Smith J, Coyle H, Fryer A, Gorry J, Gregg J, Mawer G, Nicolaides P, Pickering L, Tunnicliffe L, Chadwick DW J Neurol Neurosurgsychiatry 2004;75:1575–1583 Objectives To determine the prevalence of cognitive delay and possible associated dysmorphic features in children exposed to antiepileptic drugs (AEDs) in utero. Methods In a retrospective study of children born to mothers with epilepsy, in regional epilepsy clinics in Liverpool and Manchester, U.K., the children were aged between 6 months and 16 years and born to mothers with epilepsy. Structured interviews, hospital records, clinical examination, and psychometric tests (Wechsler) were used to assess exposure and intelligence quotient (IQ). Blinded assessment of photographs was used to score children with characteristic dysmorphic features. Results In total, 249 children aged 6 and older were studied: 41 were exposed to sodium valproate (VPA), 52 to carbamazepine, 21 to phenytoin, 49 to polytherapy, and 80 were unexposed. Mean verbal IQ was significantly lower in the VPA group compared with that in unexposed and other monotherapy groups. Multiple regression analysis showed that both VPA exposure and frequent tonic-clonic seizures in pregnancy were significantly associated with a lower verbal IQ, despite adjusting for other confounding factors. A significant negative correlation was found between dysmorphic features and verbal IQ in children exposed to VPA. Conclusions This study identifies VPA as a drug carrying potential risks for developmental delay and cognitive impairment and is the first to suggest that frequent tonic-clonic seizures have a similar effect. Our results must be interpreted with caution, given their retrospective nature. Women with epilepsy need careful counseling about individual risk benefit of AED treatment before pregnancy.