Valproate used during pregnancy: What should be done?

Abstract

Background

Sodium valproate can cause serious developmental disorders in unborn babies if taken while pregnant, especially in the first trimester.

Aim

To review recent literature and advice or treatment for women who have or are using valproate whilst pregnant.

Design

Literature review.

Methods

Literature review using Pubmed with search terms: ‘bipolar’; ‘pregnant’; ‘valproate’ and following up references.

Results

There are several small methodologically flawed studies that attempt to address this question and will be reprised. Three key population register studies found high rates of malformations. A retrospective study of longer-term outcomes found high rates of developmental issues. There are several relevant treatment guidelines, including from the National Institute for Health and Clinical Excellence (NICE). There is a 40% risk of developmental disorder, a 10% risk of congenital malformations and a 3% risk of IQ deterioration.

Conclusions

Avoid valproate in women of childbearing age if at all possible, and consider effective contraception if used. If already pregnant then consider, with involvement from the patient, stopping or minimizing the dose of sodium valproate. Assess the risks and benefits of using sodium valproate during pregnancy versus stopping the treatment for the first trimester as symptoms of the disorder may return. Seek advice from a perinatal psychiatrist. Add 5 mg of folic acid daily for the remainder of the pregnancy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.