{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:49:26Z","timestamp":1787014166278,"version":"build-2736575974"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T00:00:00Z","timestamp":1616976000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","award":["ICMR 5\/4\u20105\/152\/Neuro\/2015\u2010NCD\u20101"],"award-info":[{"award-number":["ICMR 5\/4\u20105\/152\/Neuro\/2015\u2010NCD\u20101"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","award":["ICMR No. SWG\/Neuro\/17\/2002\u2010NCD\u2010I (2003\u2010459)"],"award-info":[{"award-number":["ICMR No. SWG\/Neuro\/17\/2002\u2010NCD\u2010I (2003\u2010459)"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This is an audit of the use of valproate (VPA) during pregnancy in women with epilepsy (WWE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified all pregnancies exposed to VPA in the Kerala Registry of Epilepsy and Pregnancy between January 2010 and December 2019. Subjects' past usage of antiepileptic drugs (AEDs), seizure count before and during pregnancy, fetal outcome, and major congenital malformations (MCMs) were abstracted from the registry records. The presumed reason for usage of VPA was deducted from the clinical records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 221 pregnancies (17.75%) exposed to VPA (monotherapy,\n                      <jats:italic>n<\/jats:italic>\n                      = 149) during the audit period. The MCM rate for the completed pregnancies exposed to VPA was higher (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a020, 10.36%) than that of VPA\u2010unexposed pregnancies (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a039, 4.96%). The relative risk for MCM with VPA exposure was 2.1 (95% confidence interval = 1.24\u20133.48, number needed to treat with VPA to result in MCM = 19). Reasons for using VPA during pregnancy (some women had more than one reason) were (1) VPA was the first AED prescribed and was effective (68, 29.06%), (2) other AEDs were ineffective (128, 54.70%), and (3) other AEDs were discontinued due to adverse effects (17, 7.28%). Other reasons (21, 8.97%) were (1) VPA was selected after the epilepsy classification was revised (3, 1.28%), (2) other AEDs were expensive (2, .85%), and (3) patient switched to VPA from other AEDs for unspecified reason (16, 6.83%). VPA was discontinued during pregnancy for 6 (2.71%) persons. Less than 10% of women were tried on lamotrigine or levetiracetam before switching to VPA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Nine MCMs per thousand pregnancies can be avoided if VPA is not used in WWE. Safe and effective AEDs as alternatives to VPA are the need of the hour. Professional bodies and regulatory authorities need to implement updated guidelines on AED usage in girls and women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.16882","type":"journal-article","created":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T01:11:24Z","timestamp":1617066684000},"page":"1141-1147","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Valproate usage in pregnancy: An audit from the Kerala Registry of Epilepsy and Pregnancy"],"prefix":"10.1111","volume":"62","author":[{"given":"Balaji B.","family":"Seshachala","sequence":"first","affiliation":[{"name":"Kerala Registry of Epilepsy and Pregnancy Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manna","family":"Jose","sequence":"additional","affiliation":[{"name":"Kerala Registry of Epilepsy and Pregnancy Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arya M.","family":"Lathikakumari","sequence":"additional","affiliation":[{"name":"Kerala Registry of Epilepsy and Pregnancy Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sruthy","family":"Murali","sequence":"additional","affiliation":[{"name":"Kerala Registry of Epilepsy and Pregnancy Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun S.","family":"Kumar","sequence":"additional","affiliation":[{"name":"Kerala Registry of Epilepsy and Pregnancy Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5307-3551","authenticated-orcid":false,"given":"Sanjeev V.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Kerala Registry of Epilepsy and Pregnancy Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30107-8"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13632"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001772"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2013-306318"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182574f39"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2018.12.006"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2008.01.010"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0803531"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(12)70323-X"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2015.09.003"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.16685"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.2270"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002119"},{"key":"e_1_2_8_15_1","unstructured":"Royal College of Obstetricians & Gynaecologists.Epilepsy in pregnancy (Green\u2010top Guideline No. 68).2016.https:\/\/www.rcog.org.uk\/en\/guidelines\u2010research\u2010services\/guidelines\/gtg68\/. Accessed 5 Jan 2021."},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31866-4"},{"key":"e_1_2_8_17_1","unstructured":"European Medicines Agency.PRAC recommends new measures to avoid valproate exposure in pregnancy.2018.https:\/\/www.ema.europa.eu\/en\/news\/prac\u2010recommends\u2010new\u2010measures\u2010avoid\u2010valproate\u2010exposure\u2010pregnancy. Accessed 6 Jan 2021."},{"key":"e_1_2_8_18_1","unstructured":"GOV.UK.Valproate use by women and girls. 2018. Available from:https:\/\/www.gov.uk\/guidance\/valproate\u2010use\u2010by\u2010women\u2010and\u2010girls. Accessed 7 Jan 2021."},{"key":"e_1_2_8_19_1","unstructured":"Thirteen UK healthcare bodies launch \u201cpragmatic\u201d guidance on valproate use. 2019.https:\/\/www.rcgp.org.uk\/about\u2010us\/news\/2019\/march\/thirteen\u2010uk\u2010healthcare\u2010bodies\u2010launch\u2010pragmatic\u2010guidance\u2010on\u2010valproate\u2010use.aspx. Accessed 6 Jan 2021."},{"key":"e_1_2_8_20_1","unstructured":"Valproate in children young people and adults: summary of NICE guidance and safety advice.https:\/\/www.nice.org.uk\/guidance\/cg137\/resources\/valproate\u2010in\u2010children\u2010young\u2010people\u2010and\u2010adults\u2010summary\u2010of\u2010nice\u2010guidance\u2010and\u2010safety\u2010advice\u2010pdf\u20106723784045. Accessed 7 Jan 2021."},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.2009.01260.x"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2017-317368"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02093.x"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2018.04.009"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2019.106250"},{"key":"e_1_2_8_26_1","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.4103\/0028-3886.304110","article-title":"Grid\u2010based preconception counseling can facilitate shared decision making for women with epilepsy","volume":"68","author":"Thomas SV","year":"2020","journal-title":"Neurol India"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13437"},{"key":"e_1_2_8_28_1","doi-asserted-by":"crossref","first-page":"674","DOI":"10.4103\/aian.AIAN_264_19","article-title":"Antiepileptic drug prices, availability and affordability in a resource\u2010limited setting","volume":"23","author":"Singh K","year":"2020","journal-title":"Ann Indian Acad Neurol"},{"key":"e_1_2_8_29_1","doi-asserted-by":"crossref","unstructured":"Trends in catastrophic health expenditure in India: 1993 to 2014. 2017.http:\/\/www.who.int\/bulletin\/volumes\/96\/1\/17\u2010191759\/en\/. Accessed 14 Jan 2021.","DOI":"10.2471\/BLT.17.191759"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40360-015-0043-8"},{"key":"e_1_2_8_31_1","unstructured":"National Health Portal of India.Essential drugs. 2015.https:\/\/www.nhp.gov.in\/essential\u2010drugs_mtl. Accessed 8 Jan 2021."},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.4103\/jfmpc.jfmpc_302_19"},{"key":"e_1_2_8_33_1","unstructured":"NITI Aayog (National Institution for Transforming India) Government of India.Health performance.http:\/\/social.niti.gov.in\/hlt\u2010ranking. Accessed 13 Feb 2021."},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40278-017-36436-9"},{"key":"e_1_2_8_35_1","unstructured":"Epilepsy India.Indian guidelines for the management of epilepsy: GEMIND.http:\/\/www.epilepsyindia.org\/gemind\u2010main_ies.html. Accessed 13 Feb 2021."},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/epi4.12420"}],"container-title":["Epilepsia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/epi.16882","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/epi.16882","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/epi.16882","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T22:59:47Z","timestamp":1724713187000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/epi.16882"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,29]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1111\/epi.16882"],"URL":"https:\/\/doi.org\/10.1111\/epi.16882","archive":["Portico"],"relation":{},"ISSN":["0013-9580","1528-1167"],"issn-type":[{"value":"0013-9580","type":"print"},{"value":"1528-1167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,29]]},"assertion":[{"value":"2021-01-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}