Steer Clear When Possible; Planning Ahead Critical

Current guidelines from the American Academy of Neurology recommend avoiding valproic acid in pregnant women, if possible, because of the risk for major congenital malformations as well as poor cognitive outcomes.

"In my group, we steer away from [valproic acid] unless it is the only drug that works," Sandra L. Helmers, MD, MPH, who was not involved in the study, noted in a telephone interview with Medscape Neurology.

Because switching drugs during or just before pregnancy is difficult, a forward-thinking approach is important, she added.

"This new study again emphasizes how important this issue is in not only women who are pregnant but women of childbearing age. That means you have to plan ahead, from day 1 — that means teenage women with epilepsy — and discuss this with them," added Dr. Helmers, who is an associate professor of neurology and pediatrics at Emory University School of Medicine in Atlanta and a member of the American Academy of Neurology.

Dr. de Jong-van den Berg and coauthors and Dr. Helmers have disclosed no relevant financial relationships.

N Engl J Med. 2010;362:2185-2193.

[Medscape, 8/10/10]