Association of Prenatal Exposure to Valproate and Other Antiepileptic Drugs With Risk for Attention-Deficit/Hyperactivity Disorder in Offspring

Chris­tensen et al, JAMA, Jan 2019

Impor­tance  Val­proate is an antiepilep­tic drug (AED) used in the treat­ment of epilep­sy and many oth­er neu­ro­log­i­cal and psy­chi­atric dis­or­ders. Its use in preg­nan­cy is asso­ci­at­ed with increased risks of con­gen­i­tal mal­for­ma­tions and adverse neu­rode­vel­op­ment in the off­spring and may be asso­ci­at­ed with an increased risk of atten­tion-deficit/hy­per­ac­tiv­i­ty dis­or­der (ADHD).

Objec­tive  To deter­mine whether pre­na­tal expo­sure to val­proate and oth­er AEDs is asso­ci­at­ed with an increased risk of ADHD in the off­spring.

Expo­sures  Mater­nal use of val­proate and oth­er AEDs in preg­nan­cy.

Main Out­comes and Mea­sures  Cox regres­sion esti­mates of the haz­ard ratio of ADHD. Esti­mates were adjust­ed for poten­tial con­founders.

Con­clu­sions and Rel­e­vance  Mater­nal use of val­proate, but not oth­er AEDs, dur­ing preg­nan­cy was asso­ci­at­ed with an increased risk of ADHD in the off­spring. These find­ings have impor­tant impli­ca­tions for the coun­sel­ing of women of child­bear­ing poten­tial using val­proate.