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Title: | Prenatal valproate exposure and adverse neurodevelopmental outcomes: Does sex matter? | Austin Authors: | Honybun, Eliza;Thwaites, Rebecca;Malpas, Charles B;Rayner, Genevieve ;Anderson, Alison;Graham, Janet;Hitchcock, Alison;O'Brien, Terence J;Vajda, Frank J E;Perucca, Piero | Affiliation: | Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia Clinical Outcomes Research Unit, Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia Clinical Neuropsychology Medicine (University of Melbourne) Department of Neurology, Alfred Health, Melbourne, Victoria, Australia Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia Department of Neurology, Alfred Health, Melbourne, Victoria, Australia Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia |
Issue Date: | Mar-2021 | Date: | 2021-02-05 | Publication information: | Epilepsia 2021; 62(3):709-719 | Abstract: | Prenatal exposure to the antiepileptic drug (AED) valproic acid (VPA) is associated with an increased risk of impaired postnatal neurodevelopment, including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). We aimed to evaluate the influence of sex and drug dosage on the association between prenatal VPA exposure and postnatal behavioral outcomes. The Australian Pregnancy Register of AEDs was interrogated to identify children aged 4-11 years prenatally exposed to AEDs. Parents reported on their child's behavior using the Autism Spectrum Quotient-Children's Version and the National Institute for Children's Health Quality Vanderbilt Assessment Scale for ADHD. General linear mixed-effects models were used to investigate the relationship between clinicodemographic variables and psychometric scores. A total of 121 children were studied: 54 prenatally exposed to VPA (28 males, 26 females; mean dose ± SD: 644 ± 310 mg/day) and 67 exposed to other AEDs. There was a main effect of sex showing higher ASD scores in males compared to females (p = .006). An interaction between sex and VPA exposure revealed that males had higher ASD symptoms among children exposed to AEDs other than VPA (p = .01); however, this typical sex dynamic was not evident in VPA-exposed children. There was no evidence of any dose-response relationship between VPA exposure and ASD symptoms. Males had higher ADHD scores compared to females, but there was no evidence for a link between ADHD symptoms and VPA exposure. Prenatal VPA exposure seems to negate the usual male sex-related predominance in the incidence of ASD. These initial findings deepen the concept of VPA as a "behavioral teratogen" by indicating that its effect might be influenced by sex, with females appearing particularly sensitive to the effects of VPA. No association between VPA doses and adverse postnatal behavioral outcomes was detected, possibly related to the low VPA doses used in this study. | URI: | https://ahro.austin.org.au/austinjspui/handle/1/25780 | DOI: | 10.1111/epi.16827 | ORCID: | 0000-0002-6484-5972 0000-0003-0534-3718 0000-0002-0747-3877 0000-0003-2140-2351 0000-0001-5570-7538 0000-0002-7855-7066 |
Journal: | Epilepsia | PubMed URL: | 33547648 | Type: | Journal Article | Subjects: | antiepileptic drugs attention-deficit/hyperactivity disorder autism spectrum disorder epilepsy neurodevelopment |
Appears in Collections: | Journal articles |
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