Valproate is a medication prescribed to women with epilepsy. Previous studies have shown a clear connection between the drug and birth defects, leaving some women fearful of starting a family. Since Valproate is the only medication that effectively reduces or eliminates seizures, women are left with a choice between taking a chance that their infant will be born with a malformation or disability and not having children at all. According to researchers in Australia, those two choices may not be the only two viable options.

A recent study published in the journal Neurology, reducing Valproate dosage in the first trimester of pregnancy may be enough to reduce the risk of birth defects, specifically hypospadias and spina bifida. Hypospadias is a urethral defect in male offspring and spina bifida is a spinal cord defect.

Data was collected from more than 1,700 women who suffer from epilepsy. All of the women were pregnant at the start of the study or had been pregnant in the past. Information was collected via the Australian Pregnancy Register (APR) which started collecting data in 1999.

Researchers estimate that 80% of the spina bifida cases noted in the APR data are associated with exposure to valproate. In recent years, fewer women have been using Valproate to control seizures and of the women using Valproate, doses have been lower. With these changes came a reduction in spina bifida cases. Of note is the reduction in spina bifida cases in women taking Valproate at reduced doses.

According to Frank Vajda AM, the founder of the APR and an expert in epilepsy, prescribing the lowest possible dose of Valproate to women who only respond well to that drug may reduce risk of fetal malformation and disabilities associated with the drug.

Source: Frank J. Vajda, MB, BS, MD, FRCP(Edin), FRACP, Terence J. O'Brien, MB, BS, MD, FRCP, FRACP, Janet E. Graham, RN, Cecilie M. Lander, MB, BS, FRCP, FRACP and Mervyn J. Eadie, MD, PhD, FRCP, FRACP. Dose dependence of fetal malformations associated with valproate. Published online before print August 2, 2013, doi: 10.1212/WNL.0b013e3182a43e81. Neurology 10.1212/WNL.0b013e3182a43e81.