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Updated: Aug 8, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
[Neuropsychological outcome following intrauterine exposure to valproate]
B Schmitz1, G Krämer, C Helmstädter
1Neurologische Klinik und Poliklinik, Charité, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin. bettina.schmitz@charite.de
Insights
Exposure to valproate (VPA) during pregnancy may increase risks for children, including low IQ and behavioral issues. Caution is advised for women of childbearing potential using VPA.
Area of Science:
- Neurology
- Developmental Neuroscience
- Pharmacology
Context:
- Epilepsy management in women of childbearing potential presents unique challenges.
- In utero exposure to antiepileptic drugs, specifically valproate (VPA), is a growing concern.
- Existing literature suggests potential links between prenatal VPA exposure and adverse neurodevelopmental outcomes.
Purpose:
- To review the current evidence on the association between in utero valproate exposure and neurodevelopmental problems in children.
- To provide practical recommendations for the use of valproate in women of childbearing potential.
- To highlight the need for further research into the mechanisms and extent of VPA's neurodevelopmental impact.
Summary:
- Recent studies indicate a potential association between prenatal valproate (VPA) exposure and lower IQ and behavioral disorders in children.
- Despite methodological limitations in current research, the data warrant significant caution regarding VPA use in pregnant women or those who could conceive.
- The precise mechanisms by which antiepileptic drugs like VPA may affect neurodevelopment remain largely unknown.
Impact:
- The findings underscore the critical need for careful consideration and risk-benefit assessment when prescribing VPA to women of childbearing potential.
- Highlights the urgency for prospective studies to elucidate the neurodevelopmental risks associated with prenatal VPA exposure.
- Suggests a collaborative international research effort to address this significant clinical issue.
Abstract:
A number of recent studies suggest a link between in utero exposure to valproate (VPA) and low IQ and behavioural disorders in children of mothers with epilepsy. In this review, a commission of the German Section of the International League Against Epilepsy discusses the evidence in the literature and practical recommendations for the use of VPA in women of childbearing potential. It is concluded that despite methodological shortcomings--largely due to the complexity of the problem and small case numbers in prospective studies--the existing data are sufficiently alarming to require great caution in the use of VPA in women who could become pregnant. The underlying mechanisms of how antiepileptic drugs may lead to neurodevelopmental problems are unclear. Further prospective studies are urgently needed to clarify this clinically important issue, and a collaborative study is suggested based on the international network established by the European Registry of Antiepileptic Drugs and Pregnancy.
