Overview

‘Eat well, but avoid certain foods, like dairy, raw sprouts, and seafood.’

‘Exercise regularly but avoid heavy lifting.’

‘Take your supplements.’

‘Get enough sleep.’

‘Avoid taking risks.’

We understand that pregnancy is hard enough as it is without all the rules and stipulations. However, the annoying truth of it all is that these rules are mostly there to help guide you through a healthy and uneventful pregnancy, and adhering to them is likely what is best for you and your baby.

One of these rules applies to a medication known as valproate, which should not be used when pregnant. However, due to the importance of valproate in treating several health conditions, the UK government has set rules in place surrounding the use of the drug during pregnancy.

The journey of pregnancy can be cumbersome, whether it is the first or a subsequent pregnancy. The purpose of this article is to educate you on the use of valproate during pregnancy and its effects on the baby.

Introduction

An article published in 2018 reported the continued prescription of valproate for people assigned female at birth (AFAB) with pregnancy or planning on getting pregnant, in spite of strong  evidences contradicting its use.¹

In the UK, valproate is only permitted for use during pregnancy under exceptional circumstances and with strict rules for monitoring its usage.

Uses of valproate

You may know valproate or sodium valproate, more commonly known by its branded names – dyzantil, epilim, episenta, epival, etc. It is used to treat a multitude of health conditions.

Epilepsy

Epilepsy is a neurological disorder which results in seizures. Seizures are incidents where individuals experience either one or more of the following symptoms: muscle locking, uncontrollable shaking, loss of consciousness, staring into space, or tongue biting. If left untreated, this seizure can cause brain damage or damage to other parts of the body.²

Depending on age and gender, the choice of monotherapy for epilepsy varies; sodium valproate is the go to choice in the case of generalised seizures.³ 

Bipolar and schizoaffective disorders

Bipolar disorder is a mental health condition where one can experience extreme states of mood. The two state of extremes are mania/hypomania and depression. Depression is commonly known as experiencing low energy, suicidal thoughts, and feeling hopeless.

You can differentiate between mania and hypomania, as mania tends to last longer and involve elements of psychosis, such as delusions and hallucinations; these are not typically experienced in hypomania.⁴

Valproate is one of the medicines used to treat mania in bipolar disorder, the other drug of choice being lithium.⁵ 

Migraines

Migraines are an extreme type of headache, where you experience a painful throbbing on one side of your head. You can also experience associated symptoms such as:⁶

• Nausea or sensitivity to light and sound
• An ‘aura’ – this is when you experience seeing ‘floaters’ in your vision

Valproate is not commonly used to treat migraines, it is instead used sometimes as what is known as ‘prophylaxis’, or preventive care treatment.⁷ This means valproate is used as a preventative measure in migraines rather than a curative one. 

What can happen to a baby if valproate is used during pregnancy?

Due to its various critical uses, there is an incentive for people assigned female at birth to continue to use valproate during their pregnancy. However, valproate is a teratogen, meaning it can cause birth defects. 

Evidence shows that using valproate during pregnancy can cause the baby to be born with a birth defect.⁸ Some of the birth defects that can occur with valproate use during pregnancy are:¹

• Spina bifida: a hole in the baby’s spine due to an underdeveloped spinal column
• Atrial septal defect: a hole within the wall separating the chambers of the heart
• Cleft palate: an abnormality in the development of the roof of the mouth
• Hypospadias: when the urethra is found on the underside of the penis
• Polydactyly: when the baby is born with extra fingers and/or toes
• Craniosynostosis: an abnormality in the development of the skull

Foetal valproate syndrome

Foetal valproate syndrome (FVS) is a condition that can develop in newborns that were exposed to valproate in the womb. The incidence of FVS increases in babies who were exposed to the drug during the first three months of their conception.

Babies with FVS will often be observed showing traits of autism, having facial abnormal features, and having delay in development, in addition to the birth defects listed above.⁹ 

What is the UK policy on the use of valproate during pregnancy?

Despite the potential side effects of continued use of the medication during pregnancy, the UK government recognises why some birth parents may want to or need to continue using the medication. As such, they’ve put into place the valproate pregnancy prevention programme.

According to UK regulations, an expectant or soon-to-be expectant birth parent cannot use valproate unless they are part of the programme. Being a part of the programme will include your doctor fully briefing you on the effects that valproate will have on your baby, regular check-ups in addition to your usual pregnancy check-ups, and careful monitoring of your valproate use.¹⁰ 

Can the use of valproate in people assigned male at birth affect the chances of pregnancy?

The use of valproate by people assigned male at birth (AMAB), who are planning for children isn’t as well researched and outlined as its use by AFAB. That being said, there is evidence to suggest that valproate can affect sperm mobility, depending on the dosage and duration of use. In some patients, valproate’s effect on the sperm can be reversed.¹¹

Other things to keep in mind for a healthy pregnancy

In addition to avoiding valproate, there are other things that all pregnant people in general, should keep in mind. For example, avoid smoking and drinking alcohol during this period, take your folic acid and vitamin D supplements–ask your doctor about this if they haven't spoken to you about it yet, and keep attending all your check-ups.

Summary

Valproate is generally not used during pregnancy, except in extreme cases when the preexisting physical or mental health condition, such as epilepsy or bipolar disorder, can pose a fatal threat to the lives of people assigned female at birth and their babies. In the UK, valproate is only permitted for use if the person assigned female at birth is following the valproate pregnancy prevention programme. Valproate can also affect sperm mobility, and people assigned male at birth should talk to their doctors if they intend to have children.