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Prenatal Use of Common Epilepsy Drug Tied to Higher Autism Risk
Date:4/23/2013

is also used to treat people with migraines and those with bipolar disorder, according to the author of an accompanying journal editorial, Dr. Kimford Meador, a professor of neurology at Emory University in Atlanta.

But, the medication has been linked to birth defects and to delayed mental development, according to background information in the study. Meador said that the risk of birth defects has been associated with first trimester use of valproate, whereas the risk of mental delays and the risk of autism spectrum disorders more likely stems from the use of the drug during the third trimester of pregnancy.

In any case, he added, a woman at higher risk would also need to have a genetic susceptibility that allows the drug to cause problems. That's why not everyone who takes valproate in pregnancy will have a child with birth defects or other problems.

Still, Meador said the number of women taking valproate is too high. National estimates suggest that about 926,000 prescriptions were written annually for valproate for women in their childbearing years. There is a small subset of women who can only maintain good seizure control on valproate, explained Meador, but even then, the women should be given the lowest possible dose. He said the higher the dose of the drug, the greater the risk of causing problems.

What's most important is that women understand the risks and benefits of any drug they're being given, Meador said.

"This is not a minor thing. Doctors should tell women what the risks are. And, this shouldn't be something you just think about when you're planning a pregnancy, because about half of all pregnancies in the U.S. are unplanned. The time to talk about medications is before pregnancy, and medications should be used in the lowest dose possible to control seizures," said Meador, who added, "My approach is to start with other drugs first."

However, study author Christensen said, "A number of women of childbearing p
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