Future Mothers: What the Valproate-Autism Link Means

Study links epilepsy drug to higher autism risk
Pregnant mother and child

Expectant mothers who take the drug valproate to control seizures may face an unexpected side effect: an increased risk of autism for their babies.

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A new study shows that the risk of autism increased threefold for children whose mothers took valproate, an anticonvulsant and mood-stabilizing drug, during pregnancy. If you are taking valproate and thinking about getting pregnant, should you stop taking the drug? Not so fast, says Ajay Gupta, MD, Section Head of Pediatric Epilepsy at Cleveland Clinic.

“They should see their health care providers, obstetricians and epilepsy specialists before planning pregnancy,” Dr. Gupta says. “The decision to make a change or not is often complicated by a variety of complex factors.”

Dr. Gupta says there are alternative drugs, but not all are established as safe for pregnant women or appropriate for certain types of epilepsy. Working with a doctor to continue treating epilepsy is critical for pregnant women; severe seizures expose not only the mother but also the fetus to risks.

Working with a doctor to continue treating epilepsy is critical for pregnant women; severe seizures expose not only the mother but also the fetus to risks.

What the study says

In the study, Danish researchers looked at 665,615 babies born between 1996 and 2006. They followed these children for nearly 9 years and found that 5,437 were diagnosed with autism. After identifying which mothers took valproate during pregnancy, they determined that the risk of being diagnosed with autism was 2.9 percent higher in children whose mothers took valproate.

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However, most of the women who took valproate did not have children with autism. “The risk may depend on other factors, genetic or environmental, that we yet do not understand,” Dr. Gupta, who did not participate in the study, says. “The patient should be under close supervision, and drug doses, regimen and level should be followed closely.”

Why it’s complicated

The exact cause of autism is unknown. Scientists say genetics play a big role, and infections or exposure to chemicals such as valproate during fetal development may increase the risk.

“Autism is something that develops prenatally” says Sumit Parikh, MD, who specializes in developmental delays and autism at the Center for Pediatric Neurology. In addition to genetics, Dr. Parikh says, “There are likely environmental influences as well, including parental age, toxin and drug exposures, prematurity, etc.”

Prenatal history is one piece of the puzzle when making an autism diagnosis. Doctors would consider a patient with prenatal exposure to valproate at “a slightly higher risk,” Dr. Parikh says.

For Dr. Gupta, it comes down to weighing the benefits and risks. “The best anti-seizure drug in pregnancy is the drug that provides the best safety and efficacy profile for that patient,” he says. “Most women with epilepsy have normal, healthy babies.”

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