The epilepsy drug valproate (Depacon) should not be taken by pregnant women, according to new guidelines issued by American Academy of Neurology and the American Epilepsy Society. According to a report on medpagetoday.com, the groups have also recommended that expectant mothers who need them take only one epilepsy medication at a time.
The groups, which published the new guidelines simultaneously in the journals Neurology and Epilepsia, said that in general, epileptic women can have safe pregnancies. “These guidelines show that women with epilepsy are not at a substantially increased risk of having a cesarean section, late pregnancy bleeding, or premature contractions or premature labor or delivery,” Cynthia Harden, M.D., of the University of Miami, lead author of the guidelines, said during a briefing announcing the guidelines yesterday.
However, the groups have warned pregnant women to avoid the drug valproate if possible. According to WebMD, in making the recommendation, the groups cited the drug’s association with major birth defects, including cleft palate and spinal bifida.
As we’ve been reporting for the past several months, various studies have shown valproate to be harmful to a developing fetus. Earlier this month, a study conducted by scientists at Emory University found that toddlers exposed to valproate in utero had lower IQs than those whose mothers took other epilepsy drugs. In December, we reported that a British study had found that children whose mothers had taken valproate during pregnancy were seven times more likely to develop autism than those not exposed to any epilepsy medication. The increased risk was not seen with other epilepsy drugs included in the study.
Another study published in Neurology last year found that women taking valproate along with the migraine medication Topamax were 11 times more likely to give birth to a baby with birth defects than those taking Topamax alone. Defects seen in that study included genital birth defects in male babies, a hole above the buttocks, a flattened head, toe webbing, clicky hips and immature hip joints.
The guidelines also recommend that pregnant women taking other epilepsy drugs use only one. Taking more than one medication raises the risk of birth defects compared with taking only one medication, the guidelines said.
Finally, the groups said pregnant women may also want to avoid taking phenytoin (Dilantin) and phenobarbital, as they too have been linked to lower IQs in children, WebMD said.
The guidelines also pointed out that primidone (Mysoline) and levetiracetam (Keppra) were detected in breast milk at various levels “that may be clinically important,” WebMD said. Valproate, phenobarbital, phenytoin, and carbamazepine ( Tegretol) were not, the panel says.
At yesterday’s briefing, Harden said the groups found no evidence “one way or another” that exposure to the drugs through breast milk was harmful, but suggested mothers and their doctors take this information into consideration when making decisions about breast feeding.
Other guidelines issued by the groups included:
- Pregnant women with epilepsy should have their blood tested regularly, as pregnancy has been shown to lower the levels of anti-epileptic drugs in the blood, which may put women at risk of seizures.
- Women planning to become pregnant should take at least 400 micrograms of folic acid a day, as supplementation has been shown to be “possibly effective” in preventing major birth defects.
- Smoking during pregnancy may increase substantially the risk of premature contractions and premature labor and delivery during pregnancy.
According to WebMD, the groups are recommending that epileptic women who wish to become mothers consult their doctors about seizure medications at least six months before becoming pregnant. They stressed that women should not stop taking any epilepsy medication without first talking to their physician.