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Epilepsy Meds During Pregnancy May Raise Autism Risk in Child | Health News

By Serena Gordon HealthDay Reporter

(HealthDay)

FRIDAY, Oct. 30, 2020 (HealthDay News) — Women who take the epilepsy medication valproic acid during pregnancy have more than twice the risk of having a child with autism, new research suggests.

The study also found that taking the drug during pregnancy almost doubled the odds that a child would have attention-deficit/hyperactivity disorder (ADHD), compared to children who weren’t exposed to the drug during pregnancy.

“These women are in a bind. Valproic acid is a first-line drug for epilepsy, and having uncontrolled epilepsy is also a risk to mom and baby. We’re not trying to point a finger at valproic acid, but we did see these associations,” said study author Kelsey Wiggs. She’s a doctoral candidate in the department of psychological and brain sciences at Indiana University in Bloomington.

Wiggs noted that the study wasn’t designed to prove cause-and-effect relationships, only associations.

She added that the study is important because of the associations it didn’t find, as well.

“We didn’t find an association with the antiseizure medications lamotrigine and carbamazepine,” Wiggs said.

Between three and seven women out of every 1,000 pregnant women have epilepsy — a seizure disorder. The main treatment for epilepsy is antiseizure medications, according to background information in the study. But valproic acid has been linked to a higher risk of birth defects and lower cognitive test scores (IQ and other tests), according to the U.S. Food and Drug Administration.

The drug has also been associated with a higher risk of ADHD and autism in smaller studies, the researchers noted.

The latest study included nearly 15,000 children who were born to women with epilepsy between 1996 and 2011. Nearly one in four of the mothers took antiseizure medication during their first trimester of pregnancy.

About 10% of the women took carbamazepine and 7% took the medication lamotrigine. Five percent of the women took valproic acid (699 children).

Of those who were exposed to valproic acid in pregnancy, 36 developed autism by the age of 10. There were just over 11,000 kids who weren’t exposed to any antiseizure medication. Just 154 of them were diagnosed with autism.

Fifty-four of the kids exposed to valproic acid developed ADHD by 10. In those with no exposure to the drugs, 251 out of 11,000 were diagnosed with ADHD, the study authors said.

Wiggs said it’s not clear how valproic acid exposure might trigger autism or ADHD. She said that the medication is associated with the increased metabolism of the nutrient folate. Folate is important in the development of nervous system cells, so it’s possible that may play a role.

Dr. Steven Pacia, vice chair of neurology at North Shore University Hospital in Manhasset, N.Y., said that folate might be one factor, but he suspects there are likely multiple reasons why this medication is associated with higher rates of autism and ADHD.

Pacia said this study is the largest to link valproic acid to autism and ADHD, but that the drug was already known to

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Psoriasis Meds Don’t Raise Risk of Severe COVID-19: Study | Health News

By Cara Roberts Murez, HealthDay Reporter

(HealthDay)

TUESDAY, Oct. 27, 2020 (HealthDay News) — Researchers in the United Kingdom have reassuring news for people with psoriasis based on the first analysis of a global registry of COVID-19 patients who also have the skin disease.

Moderate-to-severe cases of psoriasis are treated with drugs that suppress the immune system. This analysis of the international PsoProtect registry found that more than 90% of psoriasis patients survive infection with the new coronavirus.

“We can reassure our patients that the survival for people with psoriasis is high, and the risk factors for psoriasis patients are similar to those of the general population,” said Dr. Satveer Mahil, a consultant dermatologist at St. John’s Institute of Dermatology in London, who co-leads the registry.

The registry was established to understand how psoriasis and the medications used to treat it affect severity of COVID-19, according to a news release from the U.K.’s National Institute for Health Research.

Psoriasis is a skin disease believed to be related to an immune system problem. It causes red patches and flaky plaques of skin that are covered with silvery scales.

The findings were recently published online in the Journal of Allergy and Clinical Immunology.

For the study, the researchers analyzed 374 cases from 25 countries in which psoriasis patients had COVID-19 between March and July 2020. About 71% were taking biologic medications and 18% were taking traditional immunosuppressants. About 93% fully recovered from COVID-19, 21% were hospitalized and 2% died.

Helen McAteer is chief executive of the Psoriasis Association. She said, “From the beginning of the pandemic, we understood the importance of being proactive in order to address the many concerns expressed by people who are living with psoriasis. The PsoProtect registry is vital in helping us understand more about the interactions between psoriasis, its treatments and COVID-19 infection so patients can make the most informed choices about their care and treatment at this challenging time.”

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Unneeded Meds at Discharge Could Cause Harm

A significant number of patients leave the hospital with inappropriate drugs because of a lack of medication reconciliation at discharge, new research shows.

Proton pump inhibitors — known to have adverse effects, such as fractures, osteoporosis, and progressive kidney disease — make up 30% of inappropriate prescriptions at discharge.



Harsh Patel

“These medications can have a significant toxic effect, especially in the long term,” said Harsh Patel, MD, from Medical City Healthcare in Fort Worth, Texas.

And “when we interviewed patients, they were unable to recall ever partaking in a pulmonary function test or endoscopy to warrant the medications,” he told Medscape Medical News.

For their retrospective chart review, Patel and his colleagues assessed patients admitted to the ICU in 13 hospitals over a 6-month period in North Texas. Of the 12,930 patients, 2557 had not previously received but were prescribed during their hospital stay a bronchodilator, a proton pump inhibitor, or an H₂ receptor agonist.

Of those 2557 patients, 26.8% were discharged on a proton pump inhibitor, 8.4% on an H₂ receptor agonist, and 5.49% on a bronchodilator.

There were no corresponding diseases or diagnoses to justify continued use, Patel said during his presentation at CHEST 2020.

Button Fatigue

The problem stems from a technology disconnect when patients are transferred from the ICU to the general population.

Doctors expect that the medications will be reconciled at discharge, said one of the study investigators, Prashanth Reddy, MD, from Medical City Las Colinas in Texas.

But in some instances, clinicians unfamiliar with the case click through the electronic health record to get the patient “out of the ICU to the floor,” he explained. “They don’t always know what medications to keep.”

“They may have button fatigue, so they just accept and continue,” Reddy told Medscape Medical News.

In light of these findings, the team has kick-started a project to improve transition out of the ICU and minimize overprescription at discharge.

“This is the kind of a problem where we thought we could have some influence,” said Reddy.

One solution would be to put “stop orders” on potentially harmful medications. “But we don’t want to increase button fatigue even more, so we have to find a happy medium,” he said. “It’s going to take a while to formulate the best path on this.”

Patients are always happy to hear we’re taking them off a drug.

The inclusion of pharmacy residents in rounds could make a difference. “When we rounded with pharmacy residents, these issues got addressed,” Patel said. The pharmacy residents often asked: “Can we go over the meds? Does this person really need all this?”

Medication reconciliations not only have a positive effect on a patient’s health, they can also cut costs by eliminating unneeded drugs. And “patients are always happy to hear we’re taking them off a drug,” Patel added.

He said he remembers one of his mentors telling him that if he could get his patients down to five medications, “then you’ve achieved success as a physician.”

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