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Valproate still has place in pregnancy

With the ongoing debate about epilepsy treatment in women of childbearing age, GPs may be interested in the interim results from the UK Epilepsy and Pregnancy Register, for which I am principal investigator.

This shows a major congenital malformation rate of 5.9 per cent for sodium valporate, 2.3 per cent for carbamazepine and 2.1 per cent for lamotrigine. To date some 3,000 women have been registered with our database. Neural tube defects have been seen with all three drugs, in 0.8 per cent of children exposed to sodium valporate, 0.3 per cent carbamazepine and 0.3 per cent for lamotrigine. The figure for valporate is consistent with previously published data.

Some epidemiological studies have suggested an association between sodium valporate and a risk of developmental delay. Consequently it is widely acknowledged that women with epilepsy planning to conceive should be reviewed and counselled appropriately with regard to anti-epileptic therapy.

In my opinion sodium valporate remains an appropriate drug for some women of childbearing years, provided an informed choice has been made. Where women decide on sodium valproate, steps may be taken that can reduce the risk. These include monotherapy at the lowest effective dose and the initiation of folate supplements.

Uncontrolled seizures during pregnancy could have harmful, even fatal, consequences for mother and baby. Therefore, seizure control must remain the goal of medical therapy.

Dr JI Morrow

consultant neurologist

The Royal Victoria Hospital

Belfast

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