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New issues concerning valproate treatment during pregnancy
The teratogenic risk of antiepileptic drugs has been a clinical concern for at least three decades. In an ideal world this risk would be balanced against the benefits of reduced foetal exposure to seizures due to the drug. In the real world, however, statistical data on both sides of this equation are limited. Although it has long been held that maternal seizures during pregnancy can damage the developing foetus, there is actually little hard data to support this view. Convulsive attacks certainly carry some risk—especially in later pregnancy—not least because of the mechanical dangers of convulsions, but the extent of the overall risk is unclear. It also seems inherently unlikely that the short lived anoxia occurring in seizures will have a profound effect on the foetus, although this has often been postulated. The risks of non-convulsive seizures or myoclonus are …