Not only is valproate used in the management of epilepsy, but it is also commonly used for bipolar mood disorder and for migraine prophylaxis in some countries. Various medicines regulatory agencies around the world have been strengthening their warnings of the risks associated with exposure to valproate in utero.

A number of recent studies have reported a high risk of developmental problems in children exposed to valproate in utero. Some 30-40% of preschool children displayed developmental problems such as delayed walking and talking, poor memory, speech and language difficulties and lower intellectual ability.

In addition to this, previous studies have already found an increased risk of autistic spectrum disorders – approximately three times that of the general population – and an increased risk of autism of about five times that of the general population. Limited data also suggest that the risk of developing ADHD may be increased.

Furthermore, the risk of congenital malformations (e.g. cleft palate, neural tube defects) is between 6.7-12.4% compared with 2-3% in the general population.

Patients who can become pregnant need to be well-informed of the potential risks and the need for effective contraception and pregnancy planning. Doses in excess of 1000 mg/day should be avoided wherever possible. Patients who become pregnant while on valproate should not stop their own medication, but should contact their doctors urgently.

As always risk vs benefit needs to be carefully assessed, bearing in mind that seizures in pregnancy and other antiepileptic drugs are also associated with congenital malformations and developmental issues to some extent.