1 Cognitive outcomes for children exposed to valproate in utero as a result of maternal epilepsy: a systematic review

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ObjectiveSodium valproate, otherwise termed valproate, has been suggested in the literature to be associated with a wide variety of congenital abnormalities. These abnormalities can occur in children as a result of intrauterine exposure due to maternal epilepsy. Some of these deficits are cognitive in nature. The purpose of this systematic literature review was to provide evidence of a search that was undertaken in order to gain an understanding of these cognitive deficits. The aim was to assess the quality of the evidence and to draw as concrete conclusions as it permits.MethodThis systematic literature review was performed with adherence to the PRISMA checklist and search flow. Database searching involved Medline, Embase, PsycINFO, as well as Google Scholar, ClinicalTrials.gov, and Web of Science.ResultsResults indicate that valproate exposure in utero can lead to deficiencies in intelligence quotient (IQ), language abilities, cognitive fluency, and originality. Findings also suggest that valproate-exposed children require more special educational assistance, experience more developmental delay, and are more prone to autism than non-exposed children and children exposed to other antiepileptic drugs in utero.ConclusionThe literature provides compelling evidence for cognitive impairment due to valproate exposure in utero. One advantage of the evidence is that most of the included studies are prospective in nature. However, the data that they provide should be interpreted with some degree of discretion. Due to ethical considerations and the nature of the topic under investigation, studies can at best provide evidence of an association and cannot show true causation. Finally, the ethics of prescribing valproate to pregnant epileptics and possibilities for future research are discussed.

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