If she is taking valproate and wants to get pregnant?
Valproate is an ASM used to treat epilepsy. It can be very effective in controlling seizures, but if a woman with epilepsy gets pregnant while on valproate, her baby is at risk of serious birth defects and developmental disorders. Taking folic acid does not reduce this risk.
While valproate is not suitable for women of childbearing age who could become pregnant, in some instances it may be the only choice where other treatment options have not worked. In these cases, very careful measures must be put in place to prevent pregnancy.
Where a woman on a medication containing valproate takes the decision to become pregnant, despite the risks, then the woman must be fully aware of, and accept, the high probability of serious birth defects in her baby.
The risks of taking valproate in pregnancy
For women who take valproate while pregnant:
- About 10 babies in every 100 will have a birth defect, compared with about two to three babies in every 100 for women in general. These include:
- Spina bifida – where the bones of the spine do not develop properly
- Face and skull malformations – including cleft lip and cleft palate, when the upper lip or bones in the face are split
- Malformations of the limbs, heart, kidney, urinary tract and sexual organs
- Hearing problems or deafness.
- Between 30 and 40 children in every 100 will have developmental problems, such as:
- Being late in learning to walk and talk
- Lower intelligence than other children of the same age
- Poor speech and language skills
- Memory problems.
- Increased risk of autism or autism spectrum disorders, and of attention deficit hyperactivity disorder (ADHD)
In February 2018, the European Medicines Agency (EMA) introduced measures to reduce the risk of exposure of unborn babies to valproate. Most EU countries have put these in place, and the UK also has a safety programme.