5
Neurodevelopmental Outcomes
5A. To reduce the risk of poor neurodevelopmental outcomes, including
autism spectrum disorder (ASD) and lower IQ, in children born to
PWECP, clinicians must avoid the use of valproic acid in PWECP, if
clinically feasible (Level A).
5B. Clinicians must counsel PWECP who are treated with, or are
considering starting, valproic acid that in utero exposure to valproic
acid is likely or possibly associated with a decrease in full-scale,
verbal, and non-verbal IQ, as compared to other studied ASMs (i.e.,
carbamazepine, gabapentin, lamotrigine, levetiracetam, phenytoin,
and topiramate) (Level A).
5C. Clinicians must counsel PWECP who are treated with, or are
considering starting, valproic acid that in utero exposure to valproic
acid is possibly associated with an increased risk of ASD as
compared to other studied ASMs (i.e., carbamazepine, clonazepam,
levetiracetam, and lamotrigine) (Level A).
5D. Clinicians should implement age-appropriate developmental
screening in children exposed to any ASM in utero born to PWECP
(Level B).
Folic Acid
6A. Clinicians should prescribe at least 0.4 mg of folic acid
supplementation daily preconceptionally and during pregnancy to
any PWECP treated with an ASM to decrease the risk of NTDs in the
offspring (Level B).
6B. Clinicians must prescribe at least 0.4 mg of folic acid supplementation
daily preconceptionally and during pregnancy to any PWECP treated
with an ASM to possibly improve neurodevelopmental outcomes such
as ASD and global IQ in the offspring (Level A).
6C. Clinicians should counsel PWECP treated with an ASM that adherence
to recommended folic acid supplementation preconceptionally and
during pregnancy is important to minimize the risk of MCMs and poor
neurodevelopmental outcomes (Level B).
