Posted by SLS on May 1, 2009, at 17:17:16
There is an article on Medscape reporting that the use of Depakote (valproate) during pregnancy can result in children having reduced cognitive development and lower IQ scores.
http://cme.medscape.com/viewarticle/701899?src=mpnews&spon=12&uac=41170BN
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Study Highlights
* The NEAD study was a prospective, observational, multicenter cohort study that enrolled participants in the United States and the United Kingdom between 1999 and 2004.
* Inclusion criteria were pregnant women with epilepsy who were taking a single antiepileptic drug (carbamazepine, lamotrigine, phenytoin, or valproate).
* The planned primary analysis is a comparison of neurodevelopmental outcomes at age 6 years after fetal exposure to different antiepileptic drugs.
* This planned interim analysis describes cognitive outcomes in 309 children at age 3 years.
* Children's IQ scores at age 3 years were adjusted for maternal IQ, maternal age, antiepileptic-drug dose, gestational age at birth, and maternal use of folate before conception.
* Idiopathic generalized epilepsy was the most common diagnosis in mothers taking valproate.
* Compared with children exposed to other antiepileptic drugs in utero, those with fetal exposure to valproate had significantly lower IQ scores at age 3 years.
* Adjusted mean IQ at age 3 years was 101 for children exposed to lamotrigine, 99 for those exposed to phenytoin, 98 for those exposed to carbamazepine, and 92 for those exposed to valproate.
* Mean IQ score for children exposed to valproate was 9 points lower vs those exposed to lamotrigine (95% confidence interval [CI], 3.1 - 14.6; P = .009), 7 points lower vs phenytoin (95% CI, 0.2 - 14.0; P = .04), and 6 points lower vs carbamazepine (95% CI, 0.6 - 12.0; P = .04).
* There was a dose-dependent association between valproate exposure and IQ.
* In children exposed in utero to carbamazepine, lamotrigine, or phenytoin, children's IQs were associated with maternal IQs.
* In children exposed in utero to valproate, there was no apparent association of children's IQs with maternal IQs.
* The investigators conclude that in utero exposure to valproate vs other commonly used antiepileptic drugs is associated with an increased risk for impaired cognitive function at age 3 years.
* The investigators suggest that these findings support a recommendation that valproate not be used as a first-choice drug in women of childbearing potential.
* Limitations of this study include relatively small sample, lack of randomization, lack of a control group of unexposed children, relatively young age of the children when evaluated, and possible confounding factors related to baseline characteristics.Clinical Implications
* Compared with children exposed to other antiepileptic drugs in utero, those exposed to valproate had significantly lower mean IQ scores at age 3 years. There was a dose-dependent association between valproate exposure and IQ.
* In children exposed in utero to carbamazepine, lamotrigine, or phenytoin, but not valproate, children's IQs were associated with maternal IQs.
poster:SLS
thread:893767
URL: http://www.dr-bob.org/babble/20090426/msgs/893767.html