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A recent evidence-based review of prospective cohort studies of major congenital malformations (MCMs) after exposure to antiepileptic drugs (AEDs) concluded that intrauterine, first-trimester exposure to valproic acid (VPA) is highly likely to increase the risk for MCMs compared with use of either no AED or a few other individual AEDs (JW Womens Health June 11 2009). However, associations with specific MCMs were statistically limited by the designs of the studies. Now, researchers have employed a reverse approach, using the European Surveillance of Congenital Anomalies (EUROCAT) antiepileptic-study database, a population-based registry of congenital anomalies from 14 countries.
Using data from eight published cohort studies of outcomes after…