Antiepileptic drug use during pregnancy: sodium valproate is associated with lower offspring IQ

Arkilo, Dimitrios; Vaou, Eleni Okeanis

doi:10.1136/eb-2014-102045

Cited by 2 publications

(2 citation statements)

References 7 publications

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“… 32 , 33 The use of sodium valproate during the first trimester has been associated with major malformations and long-term complications in the form of developmental delay, lower intelligence quotient, and a higher risk of the development of autism spectrum disorder. 32 , 34 , 35 It is worrisome that the majority of studied psychiatric patients in Saudi Arabia are receiving antipsychotic agents. Moreover, lithium is rarely used in women of childbearing age compared to valproate, which is linked to serious teratogenicity and other adverse effects.…”

Section: Discussionmentioning

confidence: 99%

Patterns of psychotropic medication use in inpatient and outpatient psychiatric settings in Saudi Arabia

Alosaimi

Alhabbad

Abalhassan

et al. 2016

NDT

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ObjectiveTo study the pattern of psychotropic medication use and compare this pattern between inpatient and outpatient psychiatric settings in Saudi Arabia.MethodThis cross-sectional observational study was conducted between July 2012 and June 2014 on patients seeking psychiatric advice at major hospitals in five main regions of Saudi Arabia. Male (n=651) and female (n=594) patients who signed the informed consent form and were currently or had been previously using psychotropic medications, irrespective of the patient’s type of psychiatric diagnosis and duration of the disease, were included. A total of 1,246 patients were found to be suitable in the inclusion criteria of whom 464 were inpatients while 782 were outpatients.ResultsSeveral studied demographic factors have shown that compared with outpatients, inpatients were more likely to be male (P=0.004), unmarried (P<0.001), have less number of children (1–3; P=0.002), unemployed (P=0.001), have a lower family income (<3,000 SR; P<0.001), live in rural communities (P<0.001), have a lower body mass index (P=0.001), and are smokers (P<0.001); however, there were no differences with regard to age or educational levels. The current frequency of use of psychotropic medications in overall patients was antipsychotics (76.6%), antidepressants (41.4%), mood stabilizers (27.9%), and antianxiety (6.2%). However, compared to outpatients, the current use of medications for inpatients was more frequent (93.8% vs 89.9%, P=0.019) with inpatients more likely to be treated with multiple medications (2.1 vs 1.8 medications). A similar trend was observed in the case of antipsychotics, high potency first-generation antipsychotics, second-generation antipsychotics, mood stabilizers, and antianxiety medicines where inpatients were more frequently treated with these medications for all psychiatric diagnoses when compared with outpatients. On the contrary, in the case of antidepressant treatment, an opposite trend was observed with more number of treated outpatients in comparison to inpatients. Among elderly patients, 75.9% received antipsychotics, mainly second-generation formulations (67.2%), whereas only 41% received antidepressants and 13.8% received mood stabilizers.ConclusionBased upon the present study data, it is concluded that among all the psychotropic medications, antipsychotics were heavily used and the frequency was found to be significantly high in the case of inpatients compared with outpatients. Such a practice may lead to multiple negative consequences among the Saudi psychiatric patient population. Further, extensive use of sodium valproate in the case of bipolar disorder, and also among females either in childbearing age or during pregnancy is also the cause of concern and warrants logical use. Overall, this study may help in assessing the burden of psychiatric illness within specific patient demographics and might be effectively used to strategically plan health resources allocation, generate new treatment hypothesis, or be used as a source of evidence that could f...

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Section: Discussionmentioning

confidence: 99%

Patterns of psychotropic medication use in inpatient and outpatient psychiatric settings in Saudi Arabia

Alosaimi

Alhabbad

Abalhassan

et al. 2016

NDT

View full text Add to dashboard Cite

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“…As well as its teratogenic effects, valproate may lead to problems after birth, including immediate withdrawal effects such as jitteriness [ 40 ]. Valproate therapy during pregnancy has been shown to correlate with longer-term neurodevelopmental problems leading to repetitive behaviours, impaired communication and social isolation [ 43 , 44 ], as well as reduced IQ [ 45 ]. These autistic-like traits have been demonstrated in both animal models [ 46 , 47 ] and human studies, affecting around 40% of children exposed to valproate [ 48 , 49 ].…”

Section: Main Textmentioning

confidence: 99%

Sodium valproate in pregnancy: what are the risks and should we use a shared decision-making approach?

Macfarlane

Greenhalgh

2018

BMC Pregnancy Childbirth

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BackgroundDespite significant teratogenic risks, sodium valproate is still widely prescribed in many countries to women of childbearing age, as a mood stabiliser in bipolar disorder and also in epilepsy. The UK has recently banned valproate use in women who are not in a pregnancy prevention programme. Whilst this ruling reflects prevailing clinical practice, it also highlights an ongoing debate about when (if ever) a woman who is or could become pregnant should be allowed to choose to take valproate.Main bodyWe review the benefits and harms of drugs available for bipolar disorder and epilepsy in women of childbearing age, with a particular focus on teratogenic risk. We speculate on hypothetical rare situations in which potential benefits of valproate may outweigh potential harms in such women. We also review the literature on shared decision-making – on which there is now a NICE guideline and numerous evidence-based decision tools. Drawing on previous work by experts in shared decision-making, we offer a list of ‘frequently asked questions’ and a matrix of options to support conversations with women about continuing or discontinuing the drug in (or in anticipation of) pregnancy. We also consider whether shared decision-making is an appropriate paradigm when considering whether to continue a teratogenic drug.ConclusionWe conclude that because valproate in pregnancy remains the subject of such debate, there is scope for further research – not only into the relative efficacy and safety of alternatives to it – but also into the dynamics of communication and shared decision-making in this situation.

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Antiepileptic drug use during pregnancy: sodium valproate is associated with lower offspring IQ

Cited by 2 publications

References 7 publications

Patterns of psychotropic medication use in inpatient and outpatient psychiatric settings in Saudi Arabia

Patterns of psychotropic medication use in inpatient and outpatient psychiatric settings in Saudi Arabia

Sodium valproate in pregnancy: what are the risks and should we use a shared decision-making approach?

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