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The full study and set of recommendations aren't available yet. I'm going by the New York Times article. Apparently, somebody did a statistical study on the children of women who took Depakote while they were pregnant, comparing them to the children of women who took other anti-seizure meds.
http://www.nytimes.com/2009/04/16/health/research/16child.html?hpw
Comparing IQ scores at 2 and 3 found a small but statistically significant difference. 6-8 points, difference. They looked at 303 children, which is a small group but not completely ridiculous (as opposed to studies that try to draw sweeping conclusions from 15-patient samples.) So they concluded:
The first problem is the idea that discovering something might cause problems in pregnancy is a reason for restrictions on "women of childbearing age," rather than some subset of that group. (Women of childbearing intentions, perhaps? Sexually active heterosexuals of childbearing age?) I realize that plans change, accidents happen, and a teenager isn't going to call her neurologist either after a rape or after starting to experiment with her boyfriend. Nevertheless. I'd like to hope the Atlanta neurologists who did the study took a more nuanced view, that was only simplified for the newspaper summary. It doesn't really matter. Most doctors will only read the abstract, and are likely to remember a sentence at most.
This isn't like making sure everybody gets enough folic acid. Imposing more limits than necessary on the range of possible anti-seizure meds can be a serious problem. As a woman of childbearing age who is never going to have a child, it scares me even though I can't imagine a situation where I would be willing to take Depakote. I got horrible side effects when I tried it. That brings us to the second problem: only breakthrough seizures are recognized as justifying use of Depakote in women of childbearing age. It is reasonably common to change anti-seizure meds when a person has troubling side effects with one med and hopes to get the same seizure control (or migraine prevention, or whatever) with fewer side effects. Because the study found a relatively small danger in utero, the authors recommend prescribing Depakote if nothing else can control seizures. Generous of them.
Once upon a time, I met a woman from Atlanta with partial seizures and out-of-control side effects. Her doctor just couldn't *believe* that a married woman her age (I think it was early 30s) could avoid having a second child, could seriously want to avoid it. The doctor thought the possible risk to a hypothetical fetus was more important than the woman in front of him, coming back again and again to tell him about disabling side effects and beg him to prescribe something else. She left Atlanta. She found a better doctor, and meds that aren't so hard on her body. But I feel like I'm racing to get to menopause before standard medical practice (and insurance formulary guidelines) make the universal substitution "not for women of childbearing age" for "not during pregnancy."
http://www.nytimes.com/2009/04/16/health/research/16child.html?hpw
Comparing IQ scores at 2 and 3 found a small but statistically significant difference. 6-8 points, difference. They looked at 303 children, which is a small group but not completely ridiculous (as opposed to studies that try to draw sweeping conclusions from 15-patient samples.) So they concluded:
Physicians involved in the study warned that valproate should never be the first choice for use in women of childbearing age, though exceptions may be made if a woman’s epileptic seizures cannot be controlled with other available medications.
The first problem is the idea that discovering something might cause problems in pregnancy is a reason for restrictions on "women of childbearing age," rather than some subset of that group. (Women of childbearing intentions, perhaps? Sexually active heterosexuals of childbearing age?) I realize that plans change, accidents happen, and a teenager isn't going to call her neurologist either after a rape or after starting to experiment with her boyfriend. Nevertheless. I'd like to hope the Atlanta neurologists who did the study took a more nuanced view, that was only simplified for the newspaper summary. It doesn't really matter. Most doctors will only read the abstract, and are likely to remember a sentence at most.
This isn't like making sure everybody gets enough folic acid. Imposing more limits than necessary on the range of possible anti-seizure meds can be a serious problem. As a woman of childbearing age who is never going to have a child, it scares me even though I can't imagine a situation where I would be willing to take Depakote. I got horrible side effects when I tried it. That brings us to the second problem: only breakthrough seizures are recognized as justifying use of Depakote in women of childbearing age. It is reasonably common to change anti-seizure meds when a person has troubling side effects with one med and hopes to get the same seizure control (or migraine prevention, or whatever) with fewer side effects. Because the study found a relatively small danger in utero, the authors recommend prescribing Depakote if nothing else can control seizures. Generous of them.
Once upon a time, I met a woman from Atlanta with partial seizures and out-of-control side effects. Her doctor just couldn't *believe* that a married woman her age (I think it was early 30s) could avoid having a second child, could seriously want to avoid it. The doctor thought the possible risk to a hypothetical fetus was more important than the woman in front of him, coming back again and again to tell him about disabling side effects and beg him to prescribe something else. She left Atlanta. She found a better doctor, and meds that aren't so hard on her body. But I feel like I'm racing to get to menopause before standard medical practice (and insurance formulary guidelines) make the universal substitution "not for women of childbearing age" for "not during pregnancy."
