Valproate taken in pregnancy carries a high risk of major congenital malformations and of neurodevelopmental disorders in the child. Regulators including the MHRA and EMA restrict its use in girls and women of childbearing potential to situations where other treatments are ineffective or not tolerated, with a pregnancy prevention programme in place.
When valproate is used, the reasons, the counselling given and the contraception plan should be recorded, and the decision revisited as a girl approaches puberty.
- Consider alternatives to valproate first in girls and women who could become pregnant.
- Record why valproate was chosen if it is used, and the counselling given.
- Review the choice as a girl approaches puberty, not only at the first prescription.
- Ensure effective contraception and a plan for pregnancy if valproate continues.
Why it matters
A drug started in childhood is often still being taken when pregnancy becomes possible.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for neurology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free