Measures to Mitigate Sodium Valproate Use in Pregnant Women With Epilepsy

Abstract

Sodium valproate is a sodium salt of valproic acid. It is often used in the medical treatment of several conditions like epilepsy, bipolar disorder, mania, and migraines. This review debates whether the usage of valproic acid is appropriate in pregnancy. It also lists the various neonatal deformities and other teratogenic effects the said drug presents due to prenatal exposure to the drug and the implications of continuing drug therapy in certain situations. We should often weigh the outcomes and implement it only in conditions where its use is inevitable. It also includes the importance of awareness among middle-aged women with mental illness regarding the teratogenic effects of sodium valproate use and the relevance of discussion by physicians with patients regarding the usage of this drug despite being aware of the complications. It also explores other treatment options and modalities that can be used in the place of valproic acid for epilepsy and bipolar disorder in pregnant women and women of the reproductive age group, and how we can mitigate the usage of this drug by implementing various measures by referring to various guidelines present in different areas of the world. In summary, this article explores the numerous teratogenic effects sodium valproate presents in pregnancy, alternative medications, and treatment options instead of valproate. It also enumerates conditions where valproate use is necessary and how we can reduce and prevent the usage of valproate in pregnancy by opting for pregnancy prevention programs during valproate use and various other guidelines.

Valproic Acid Syndrome: A Mini Review

“…Valproate causes congenital malformations such as neural tube defects and hypospadias [12], neurodevelopmental and neurocognitive deficits [31,35,36], orofacial [25,37], musculoskeletal changes [38], cardiovascular changes [32,39]; complications at the delivery, fetal growth restriction [12,27,28].…”

“…By inhibiting the histone deacetylase enzyme, disturbances in cardiovascular morphology occur [39], in fact, it is observed in Valproic Acid Syndrome, a hypoplastic aortic arch, an abnormal aortic valve, a coarctation of the aorta [42] and an interatrial communication [32]. Reports cited that a fetus exposed to valproate was born with a coronary arteriovenous fistula [50] and two other reports cited right pulmonary artery defects [51].…”

United Kingdom National Register Study of Anti-Epileptic Medications: Suspected Foetal Congenital And Pregnancy-Associated Side Effects

“…[11] The prescription of valproic acid to women of childbearing potential is now accompanied by a Pregnancy Prevention Programme (PPP). [12][13][14] Through this, the use of sodium valproate in pregnancy has seen a significant decline; [15] however, it is still used in pregnancy. Despite a high-profile safety review, [16] medication warnings and messages to professionals, many pregnant women with epilepsy have not had the opportunity to discuss valproate with a specialist.…”