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I read with interest the results reported by the EURAP study group1 and the accompanying editorial by Drs. Pennell and Meador.2 It is now well established that valproate use should be avoided in pregnancy and in woman with epilepsy (WWE) of child-bearing age. Broad spectrum anticonvulsants such as lamotrigine and levetiracetam should be used instead. Although the research has certainly yielded results in high-income countries in North America and Europe, the unmet needs of pregnant WWE in low- and middle-income countries in Asia and Africa remain high. In most state-run hospitals in these countries, the drugs available on formulary are restricted to phenobarbital, phenytoin, carbamazepine, and valproate. In these countries, the care of pregnant WWE is not well organized. As a result, maternal and fetal mortalities during childbirth remain high. We need to bring the findings from the EURAP registry to the attention of healthcare policymakers and planners in these countries so that, in accordance with utilitarian ethics, the research translates into results for not just a few but all pregnant WWE.
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