Pregnancy valproate

Anti-epileptic drugs, such as phenytoin, carbamazepine and valproate, may lead to neural tube defects if administered during pregnancy. Concurrent administration of folate supplements, such as folic acid, is recommended. 

Valproate, carbamazepine, and other anticonvulsants pose teratogenic risks. Despite this, treatment should continue during pregnancy, as the potential threat to the fetus by a seizure is greater However, it is mandatory to administer the lowest dose affording safe and effective prophylaxis. Concurrent high-dose administration of folate may... 

Both lithium and valproate are teratogenic. In this case, women thinking of having children may be advised to switch to alternate treatments before the pregnancy. 

Omtzigt, J.G., Nau, H., Los, F.J., Pijpes, L., and Lindhout, D. (1992) The disposition of valproate and its metabolites in the late first trimester and early second trimester of pregnancy in maternal serum, urine, and amniotic fluid effect of dose, co-medication, and the presence of spina bifida. Eur J Clin Pharmacol 43 381-388. 

Lithium, valproate, and carbamazepine should be avoided in pregnancy, if possible see text for discussion. 

Atypical antipsychotics may be preferable to lithium or anticonvulsants such as Iamotrigine if treatment of bipolar disorder is required during pregnancy, but Iamotrigine may be preferable to other anticonvulsants such as valproate if anticonvulsant treatment is required during pregnancy... 

For bipolar patients, valproate should generally be discontinued before anticipated pregnancies... 

For bipolar patients, given the risk of relapse in the postpartum period, mood stabilizer treatment such as valproate should generally be restarted immediately after delivery if patient is unmedicated during pregnancy... 

Two neonates born of mothers who had taken valproate during pregnancy developed bleeding associated with fibrinogen depletion soon after birth, and one of them died from afibrinogenemia (SEDA-19, 75). 

Hepatic disease hypersensitivity to valproate pregnancy (FDA category D) children < 2 years (especially those on multiple antiwnvulsant therapy, those with congenital metabolic disorders, those with severe seizure disorders, and those with organic brain disease) pancreatitis. 

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