Hva foreligger av data om nevrokognitiv utvikling hos barn etter bruk av Valproat i svangerskapet?

Abstract

Valproate is most commonly used to treat seizures in epilepsy. It is also used to treat manic or mixed episodes associated with bipolar disorder and to prevent migraine headaches. For decades it has been known that valproate increases the risk of major congenital abnormalities when taken during pregnancy. However, little has been known in regards to its effect on neurocognitive development. The last 5-10 years there has been an increasing amount of research in this area suggesting that valproate has an adverse effect on neurodevelopment in children after being exposed in utero. This survey has reviewed published research on the topic, and most of the reviewed articles were published in 2013. Studies suggest that being exposed to valproate in utero has an adverse effect on IQ, language, behavior and the prevalence of developmental disorders. There is increasing evidence that valproate might be more teratogenic than previously known, and hence there may be a need for updated guidelines regarding treatment with valproate for women in fertile age. More research is still needed to verify these findings and look into underlying mechanisms. There is also a need for studies with longer follow up to see if this tendency consists into adolescence and adulthood. Valproate is one of the antiepileptic drugs with best seizure control and for some patients the only efficient drug. Therefore, there is a consistent clinical dilemma. In light of newly published research it is important for clinicians to be updated on the topic when counseling a patient.

Valproate is most commonly used to treat seizures in epilepsy. It is also used to treat manic or mixed episodes associated with bipolar disorder and to prevent migraine headaches. For decades it has been known that valproate increases the risk of major congenital abnormalities when taken during pregnancy. However, little has been known in regards to its effect on neurocognitive development. The last 5-10 years there has been an increasing amount of research in this area suggesting that valproate has an adverse effect on neurodevelopment in children after being exposed in utero. This survey has reviewed published research on the topic, and most of the reviewed articles were published in 2013. Studies suggest that being exposed to valproate in utero has an adverse effect on IQ, language, behavior and the prevalence of developmental disorders. There is increasing evidence that valproate might be more teratogenic than previously known, and hence there may be a need for updated guidelines regarding treatment with valproate for women in fertile age. More research is still needed to verify these findings and look into underlying mechanisms. There is also a need for studies with longer follow up to see if this tendency consists into adolescence and adulthood. Valproate is one of the antiepileptic drugs with best seizure control and for some patients the only efficient drug. Therefore, there is a consistent clinical dilemma. In light of newly published research it is important for clinicians to be updated on the topic when counseling a patient.