Effects of Valproic Acid on Pregnancy in Epilepsy Patients
Author(s): Triasti Khusfiani, Yudhisman Imran*, Irmiya Rachmiyani and Donna Adriani
Abstract
Valproic acid has long proven to be an effective drug for treating epilepsy and has been prescribed to pregnant women with epilepsy ever since. There are only few prospective studies regarding this drug during pregnancy, however several cohort studies have shown that women taking it during the first trimester have an increased risk of congenital disorders such as spina bifida, craniosynostosis, cleft palate, hypospadias, and more. Valproic acid also has a postnatal developmental disorder effect such as ADHD and ASD in children who were exposed to it before birth. Concerns about valproic acid and its teratogenic risks has led many women to discontinue their antiepileptic medication either before pregnancy or early in their pregnancy Even though it is highly recommended to minimize or even discontinue valproic acid use in pregnancy, but in some cases, the risks of discontinuing this drug may outweigh the benefits. When valproic acid was discontinued in the first trimester (the most teratogenic period) it was associated with a significantly higher incidence of generalized tonic- clonic seizures than when it was continued (33% vs 16%). Furthermore, if valproic acid is substituted for another antiepileptic drug, seizure incidence could increase by 29%. Using valproic acid during pregnancy for epilepsy patients is a growing problem where patients and doctors will be faced with a situation where they must consider in detail the benefits and risks of using this drug.
