Document Detail

Does folic acid use decrease the risk for spina bifida after in utero exposure to valproic acid?
MedLine Citation:
PMID:  20680999     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Women with child wish are advised to take folic acid supplements to reduce the risk for spina bifida. However, there is less evidence for this protective effect in women using valproic acid (VPA). We investigated the effect of folic acid in women exposed to VPA in the first trimester of pregnancy.
METHODS: A case-control study was performed with data from a population-based registry of congenital malformations. Our cases were spina bifida registrations and all other malformed registrations (excluding folic acid sensitive malformations) were used as controls.
RESULTS: The ORs for the effect of correct folic acid use were calculated among antiepileptic drug (AED) unexposed pregnancies 0.5 [95%CI: 0.3-0.7] and among VPA exposed pregnancies 1.0 [95%CI: 0.1-7.6].
DISCUSSION: Due to power-reasons, we cannot conclude that folic acid has no effect on the risk for spina bifida among VPA exposed pregnancies. Although for AED unexposed pregnancies we found a decreased risk. Results from (animal) studies support a biologically plausible association between VPA, folic acid and spina bifida. While folic acid might not be able to reduce the risk for lower spina bifida lesions caused by VPA, the use of folic acid might be important to reduce the risk for higher, folic acid sensitive spina bifida lesions. Further research is needed to get more insight in the most effective form and dose of FA in women that use VPA to reduce the risk for (higher forms of) spina bifida.
Janneke Jentink; Marian K Bakker; Cynthia M Nijenhuis; Bob Wilffert; Lolkje T W de Jong-van den Berg
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pharmacoepidemiology and drug safety     Volume:  19     ISSN:  1099-1557     ISO Abbreviation:  Pharmacoepidemiol Drug Saf     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-03     Completed Date:  2011-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9208369     Medline TA:  Pharmacoepidemiol Drug Saf     Country:  England    
Other Details:
Languages:  eng     Pagination:  803-7     Citation Subset:  IM    
Copyright Information:
2010 John Wiley & Sons, Ltd.
PharmacoEpidemiology & PharmacoEconomics, SHARE, University of Groningen, The Netherlands.
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MeSH Terms
Abnormalities, Drug-Induced / etiology,  prevention & control*
Anticonvulsants / adverse effects*,  therapeutic use
Case-Control Studies
Dietary Supplements
Folic Acid / therapeutic use*
Infant, Newborn
Pregnancy Trimester, First
Risk Factors
Spinal Dysraphism / prevention & control*
Valproic Acid / adverse effects*,  therapeutic use
Reg. No./Substance:
0/Anticonvulsants; 59-30-3/Folic Acid; 99-66-1/Valproic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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