Valproate is known to increase the risk of birth defects in higher doses, Meador said. "It is the antiepileptic drug that has the most risk for developmental disorders," he added.
"We have a lot of alternate drugs that can be tried," he said.
Only half of the prescriptions for valproate in the United States are for epilepsy; the rest are for psychiatric disorders and migraines, he noted.
Dr. Orrin Devinsky, director of the epilepsy center at NYU Langone Medical Center in New York City, agreed that valproate use should be limited.
"The increased risk of poor neurodevelopmental outcomes, including autism, must be viewed in light of the similarly increased risk of major congenital malformations," Devinsky said.
Together, he added, these risks "should make every doctor treating a woman of childbearing age with valproate make sure it is truly essential."
For more information on pregnancy and epilepsy medications, visit the Epilepsy Foundation.
SOURCES: Rebecca Bromley, Ph.D., clinical psychologist and research associate, University of Liverpool, U.K.; Kimford Meador, M.D., professor of neurology, Emory University School of Medicine, Atlanta; Orrin Devinsky, M.D., director, Epilepsy Center at NYU Langone Medical Center, and professor of neurology, neurosurgery and psychiatry, New York University School of Medicine, New York City; Jan. 20, 2013, Journal of Neurology Neurosurgery and Psychiatry, online
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