Whether you are pregnant or are planning to get pregnant, you will want to give
your baby a healthy start. During pregnancy, regular visits with your health
care provider are very important for your baby and yourself. You will also need
to drink plenty of fluids and eat a healthy diet. But, what you don’t expose
your body to is almost as important as what you do.
It is well known that alcohol consumption, recreational drugs, and cigarette
smoking increase the risk for premature birth, poor growth, birth defects, and
behavior and learning problems. You will also want to limit or avoid caffeine
and steer clear of certain foods, such as unpasteurized cheeses, milk and
juices, raw eggs, raw or undercooked meats, and certain types of fish and
shellfish that could carry food-borne illnesses like listeriosis and
toxoplasmosis, which can be life-threatening to an unborn baby and may cause
birth defects or miscarriage. Even common over-the-counter medications that are
generally safe may be considered off-limits during pregnancy, as well as certain
prescription medications because of their potential effects on the baby.
Drugs used to treat epilepsy have been linked with an increased risk of birth
defects, such as spina bifida and heart malformations. A new study shows that
pregnant women who take the epilepsy drug valproate may significantly increase
the risk of their child developing autism, a complex developmental disability
that affects a person’s ability to communicate and interact with others.
The ongoing study involved 632 children, almost half of whom were exposed to
epilepsy drugs in utero. Of those children, 64 were exposed to valproate, 44 to
lamotrigine, 76 to carbamazepine, and 65 to other epilepsy drugs or combinations
of drugs. Forty-seven children were not exposed to any anti-seizure drugs. The
children were tested for autism at one, three, and six years of age. None of the
children had a family history of autism.
The study found that 7 of the children diagnosed with autism had mothers who
took an epilepsy drug while pregnant; 4 of those children were exposed to
valproate, while the mother of a 5th child took a combination of valproate and
lamotrigine. Children whose mothers were taking valproate alone for epilepsy
were seven times more likely to develop autism, compared to children whose
mothers did not have epilepsy and were not taking any drug while pregnant.
However, the risk seen with valproate was not seen with the other epilepsy
drugs. “The potential risk for autism in this study was substantial for children
whose mothers took valproate while pregnant, but more research needs to be done
since these are early findings,” said study author Gus Baker, Ph.D., FBPsS, of
the University of Liverpool in England.
The reactions of experts are divided. Page Pennell, M.D., director of the
epilepsy program at Emory University in Atlanta, says the study suggests the
need to “consider exposure throughout the entire pregnancy” and even before
conception. Dr. Pennell says half of the pregnancies in the U.S. are unplanned,
so women of childbearing age should steer clear of valproate unless it’s the
only medication that controls seizures. “Most of these women unfortunately have
to be on a medicine. But the idea is: women of childbearing age should be on
another anti-epileptic drug.”
Conversely, Dr. Michael Goldstein, vice president of the American Academy of
Neurology, says that while doctors are aware that some anti-seizure drugs can
cause abnormalities in the brain, pregnant women with epilepsy often have to
choose between the lesser of two risks. “Prolonged seizure could cause blood
flow problems to the baby, which could cause injury,” he said. “We generally try
to avoid valproic acid in women who might be pregnant. But for some women who
have difficulty in controlling epilepsy, they’re better off taking the medicine
than having seizures. The consensus is that seizures are worse for the babies
than the medicine.”
Laureen Cassidy, a vice president for Abbott Laboratories, the makers of the
brand name valproic acid drug called Depakote, echoes the point. “Uncontrolled
seizures can cause permanent damage to the brain and for pregnant women can be
fatal for both mother and child.” She added that “the Depakote product label
makes it clear that it should not be used as a first-line treatment for women of
childbearing age. For many women, however, Depakote may be the only effective
seizure medication and that decision should be made between the patient and
physician.” Raquel Powers, another spokeswoman for the company, said it’s a
global drug and that its risks are well known.
Dr. Baker said, “women who take valproate while pregnant should be informed of
the possible risks of autism and are encouraged to discuss them with their
doctor.” He also urges those who are taking valproate not to stop their
treatment without speaking to their doctor first.
