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DG Dispatch - AAN: Folate May Not Be Recommended In Women Taking Anti-Epileptics By Cameron Johnston Special to DG News TORONTO, ON -- April 23, 1999 -- Pregnant mothers taking sodium valproate may be at risk of giving birth to a child with physical deformities even if she is taking folate supplements, a study presented at the American Academy of Neurology meeting shows. The study looked at the offspring of 52 Canadian women who went through 63 pregnancies. The results show that five percent of these children were born with neural tube defects, 10 percent had major birth defects, and 12 percent had what would be considered minor birth defects such as harelip and cleft palate. Expectant mothers who were taking more than one anti-epileptic drug -- valproate and carbamazepine in particular -- had a 22 percent risk of having a child with birth defects. Dr. Susan Duncan describes as "disturbing" the fact that these women were taking folate to minimize the risk of neural tube defects and yet they were the ones who seemed to have the worst outcomes. Folate is routinely recommended during pregnancy. Dr. Duncan is a consultant neurologist based in Manchester, England, but worked on this study while working at the Montreal Neurological Hospital. "It may be related to how the mother handles valproate and folate. It might not upregulate their folate binding proteins so they don’t metabolize folate and valproate," she said. "In the future, if we could identify those women, we might be able to establish what women who we should avoid giving valproate to." Patients involved in the study were taking from 750 to 2000 mg of valproate per day, which Dr. Duncan said is high compared with British standards. The study involved only women in Canada who were taking valproate and was part of a much larger world-wide investigation of birth defects in the children of 960 mothers who had been taking anti-epileptic medications. E-mail this page to a friend or colleague! To print, use this version