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Birth Defects Linked to Valproic Acid

6 Birth Defects More Common in Pregnant Women Who Take Epilepsy Drug
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6 Birth Defects Linked to Valproic Acid continued...

“These findings support a relationship of these malformations with valproic acid specifically rather than to antiepileptic drugs generally or to underlying epilepsy,” the researchers write. The use of this drug is not considered a marker for more severe epilepsy, but information on the type or severity of epilepsy was not available. The new study also did not include information on the doses of valproic acid that women used during pregnancy.

“It’s a phenomenal drug for seizures and bipolar illness, but I won’t use it during pregnancy if I can help it,” says Catherine Birndorf, MD, a reproductive psychiatrist in New York City and the founding director of the Payne Whitney Women's Program at The New York Presbyterian Hospital-Weill Cornell Medical Center in New York. Birndorf typically counsels women who take this drug to treat bipolar disorder, not epilepsy.

It all comes down to a woman’s personal risk and benefit profile, she says.

“The risk of untreated illnesses are great to both the woman and fetuses, and sometimes taking this medication may be the best choice,” she says. “You need to look at it on a case-by-case basis, and look at reasonable alternatives. Sometimes there are no other choices because to stay well, you must be on this specific medication at high doses."

“If you are on [valproic acid] and it’s working well, don’t do anything rash like going off your medication,” she says.  “Go to your doctor and figure out if there are safer alternatives for treating your seizure or bipolar disorder during pregnancy."

Ideally this conversation should take place before you become pregnant. “Once you are pregnant, it’s a different can of worms,” she says.

Counseling Women Before Pregnancy

“The study provides further verification of our concerns of valproic acid standing out as high risk for birth defects during pregnancy and [conferring a] higher risk than other medications we can choose to prescribe for treatment of epilepsy, migraine, and bipolar disorder during pregnancy,” says Page B. Pennell, MD, a neurologist and the  director of research in the division of epilepsy at Brigham and Women's Hospital in Boston, and the chairwoman of the professional advisory board for the Epilepsy Foundation.

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