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Does folic acid use decrease the risk for spina bifida after in utero exposure to valproic acid?
Pharmacoepidemiol Drug Saf 2010; 19(8):803-7PD

Abstract

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.

Authors+Show Affiliations

PharmacoEpidemiology & PharmacoEconomics, SHARE, University of Groningen, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20680999

Citation

Jentink, Janneke, et al. "Does Folic Acid Use Decrease the Risk for Spina Bifida After in Utero Exposure to Valproic Acid?" Pharmacoepidemiology and Drug Safety, vol. 19, no. 8, 2010, pp. 803-7.
Jentink J, Bakker MK, Nijenhuis CM, et al. Does folic acid use decrease the risk for spina bifida after in utero exposure to valproic acid? Pharmacoepidemiol Drug Saf. 2010;19(8):803-7.
Jentink, J., Bakker, M. K., Nijenhuis, C. M., Wilffert, B., & de Jong-van den Berg, L. T. (2010). Does folic acid use decrease the risk for spina bifida after in utero exposure to valproic acid? Pharmacoepidemiology and Drug Safety, 19(8), pp. 803-7. doi:10.1002/pds.1975.
Jentink J, et al. Does Folic Acid Use Decrease the Risk for Spina Bifida After in Utero Exposure to Valproic Acid. Pharmacoepidemiol Drug Saf. 2010;19(8):803-7. PubMed PMID: 20680999.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does folic acid use decrease the risk for spina bifida after in utero exposure to valproic acid? AU - Jentink,Janneke, AU - Bakker,Marian K, AU - Nijenhuis,Cynthia M, AU - Wilffert,Bob, AU - de Jong-van den Berg,Lolkje T W, PY - 2010/8/4/entrez PY - 2010/8/4/pubmed PY - 2011/1/14/medline SP - 803 EP - 7 JF - Pharmacoepidemiology and drug safety JO - Pharmacoepidemiol Drug Saf VL - 19 IS - 8 N2 - 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. SN - 1099-1557 UR - https://www.unboundmedicine.com/medline/citation/20680999/Does_folic_acid_use_decrease_the_risk_for_spina_bifida_after_in_utero_exposure_to_valproic_acid L2 - https://doi.org/10.1002/pds.1975 DB - PRIME DP - Unbound Medicine ER -