Valproic acid use during pregnancy results in an absolute risk for spina bifida of 1-2%. This increased risk is comparable to the recurrence risk for neural tube defects and warrants informed counselling and access to prenatal diagnosis. There is no substantial evidence that valproic acid use increases the risk for other specific major malformations above the increased risk due to maternal epilepsy. Valproic acid may cause a characteristic pattern of minor facial malformations. Further definition and confirmation are required, and the magnitude of the risk needs to be determined. There are inadequate data to assess the magnitude, if any, of the risks for postnatal growth abnormalities and developmental disabilities associated with the use of valproic acid during pregnancy. Birth-defect monitoring programs and international collaboration among the staffs of monitoring programs played a major role in determining that valproic acid is a human teratogen.
The issue of male germ line mutagenesis and the effects on developmental defects in the next generation has become increasingly high profile over recent years. Mutations are thought to be becoming more prevalent as a result of: exposure to chemicals in the environment, anti cancer regimes that use genotoxic agents and assisted conception techniques. In addition to the increasing frequency of mutations in the general population, attention is also being given to the effects of epigenetic events on future generations. Male-mediated Developmental Toxicity discusses these issues comprehensively and includes further analysis on the fundamental mechanisms of mutations. With both clinical and experimental sections, written by leading experts in the field, this book will appeal to both medical practitioners and researchers.
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