Here’s a startling fact: while access to antiseizure medications is improving globally, a significant number of patients may still be at risk due to unsafe prescribing practices. But here’s where it gets controversial—one of the most commonly prescribed drugs, valproate, poses serious risks to unborn children when taken by pregnant women, yet it remains widely used in many parts of the world. In a groundbreaking study led by Dr. Adrienne Chan and Professor Ian Wong of Aston University, in collaboration with the World Health Organization (WHO), researchers analyzed antiseizure medication use across 73 countries from 2012 to 2022. Their findings reveal a troubling paradox: as access to these essential medicines expands, particularly in low- and middle-income countries, the potential for harm persists due to inadequate awareness and regulation.
The study highlights that valproate, despite being classified by the WHO as an 'essential medicine,' is linked to severe birth defects and neurodevelopmental issues in babies when taken during pregnancy. These include conditions like spina bifida, cleft palate, and disorders affecting intellect, communication, behavior, and memory. Recognizing this, the WHO has issued clear guidance against prescribing valproate to women and girls of childbearing age. And this is the part most people miss—while high-income countries have implemented stricter regulations and pregnancy prevention programs to curb valproate use, many lower-income regions continue to rely on it due to the high cost or unavailability of safer alternatives.
The researchers emphasize the urgent need for global education and alignment on safe prescribing practices. Without this, the risks to unborn children remain alarmingly high. The study, commissioned by the WHO, used sales data to track medication trends but calls for further research to understand prescribing patterns within specific populations and evaluate the effectiveness of safety measures across regions. This deeper analysis is critical to ensuring that antiseizure medications are used responsibly, especially among women of childbearing age.
Dr. Chan aptly summarizes the situation: 'Our findings show that access to antiseizure medicines is expanding globally, which is good news for patients who previously had limited options. However, the continued widespread use of valproate in some regions is deeply concerning, given its known risks during pregnancy. Greater global alignment on safe prescribing and education is urgently needed to protect future generations.'
A thought-provoking question for our readers: Should valproate be reclassified or restricted further to prevent its use in women of childbearing age, even if it means limiting access for patients who may not have safer alternatives? Share your thoughts in the comments—this is a conversation that needs to happen.
For those interested in diving deeper, the study is published in eClinicalMedicine (Chan, A.Y.L., et al., 2025). And remember, while this article provides valuable insights, it’s not a substitute for professional medical advice. Always consult a healthcare provider for personalized guidance.
