Seizure · 2026
Outcomes of valproic acid withdrawal in females before or during pregnancy: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Burbano M Claudia, Couper R Grace, Espino Poul H, Burneo Jorge G
Аннотация
OBJECTIVE: The potential teratogenic effects of valproic acid (VPA) have been widely discussed; however, outcomes after VPAwithdrawal in female patients are less well known. This review summarizes the evidence on switching or withdrawing VPA in people with epilepsy of childbearing potential or during pregnancy.
METHODS: We searched Embase, MEDLINE, and Scopus databases in June 2025 for studies measuring outcomes including seizure frequency, side effects, or maternal/fetal complications, in females withdrawn from VPA before or during pregnancy. Reference lists were screened. Risk of bias assessments included the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and Quality Assessment Tool for Case Series Studies. Studies with comparison groups and common outcomes were included in meta-analyses.
RESULTS: The systematic review included nine studies, and meta-analysis included three studies. Overall, 277 females who were pregnant or planning pregnancy withdrew or switched from VPA, while 2206 remained on VPA.We calculated odds ratios of tonic-clonic seizures (TCS) recurrence in females with VPA changes compared with females maintained on VPA using random-effect models. Females planning pregnancy and pregnant females withdrawn from VPA had an increased odds ratio of TCS recurrence during pregnancy (OR 1.73, 95% CI 1.06-2.84). Between 7.9% and 72.2% females withdrawn from VPA before or during pregnancy later restarted VPA.
CONCLUSION: Withdrawal of VPA during pregnancy had significantly higher odds ratio of TCS recurrence compared with maintenance of VPA. Evidence on fetal outcomes or maternal complications remain limited; studies with longer-term outcomes beyond pregnancy are needed.
METHODS: We searched Embase, MEDLINE, and Scopus databases in June 2025 for studies measuring outcomes including seizure frequency, side effects, or maternal/fetal complications, in females withdrawn from VPA before or during pregnancy. Reference lists were screened. Risk of bias assessments included the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and Quality Assessment Tool for Case Series Studies. Studies with comparison groups and common outcomes were included in meta-analyses.
RESULTS: The systematic review included nine studies, and meta-analysis included three studies. Overall, 277 females who were pregnant or planning pregnancy withdrew or switched from VPA, while 2206 remained on VPA.We calculated odds ratios of tonic-clonic seizures (TCS) recurrence in females with VPA changes compared with females maintained on VPA using random-effect models. Females planning pregnancy and pregnant females withdrawn from VPA had an increased odds ratio of TCS recurrence during pregnancy (OR 1.73, 95% CI 1.06-2.84). Between 7.9% and 72.2% females withdrawn from VPA before or during pregnancy later restarted VPA.
CONCLUSION: Withdrawal of VPA during pregnancy had significantly higher odds ratio of TCS recurrence compared with maintenance of VPA. Evidence on fetal outcomes or maternal complications remain limited; studies with longer-term outcomes beyond pregnancy are needed.