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MORE EVIDENCE TO AVOID VALPROATE IN PREGNANCY
What advice should we offer women wishing to become pregnant but taking valproate for epilepsy? IQ differences in offspring were detected as early as aged 3 years in this prospective study of 309 pregnant women taking monotherapy carbamazepine, lamotrigine, phenytoin or valproate. Mean IQ was 100 (2) on the first three medications but nine points lower (95% CI 3.1 to 14.6; p = 0.009) on valproate compared with lamotrigine. These are not randomised data (of course) but the neuropsychologists were blinded to the mothers’ drugs and attempted to control for a wide number of appropriate confounders. The IQ differences appear to be dose related so the advice should be that where valproate is essential, target the lowest effective dose.
N Engl J Med 2009;360:1597–605.
PARENTAL AGE IS IMPORTANT TOO
New parents in the western world are getting older. Using the Collaborative Perinatal Project data, a large birth cohort of more than 50 000 children born between 1959 and 1965 in the USA …
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