Fetal Valproate Syndrome - Still a Problem Today!

Area of Science:

• Neurology
• Teratology
• Obstetrics

Background:

• Valproate is an anticonvulsant with known teratogenic effects.
• Fetal exposure to valproate is associated with significant congenital anomalies and neurodevelopmental deficits.
• The risk of teratogenicity may be increased when valproate is used concurrently with other antiepileptic medications.

Purpose of the Study:

• To report two cases of fetal valproate syndrome.
• To highlight the spectrum of anomalies associated with prenatal valproate exposure.
• To emphasize the importance of prophylactic measures in pregnant women with epilepsy.

Main Methods:

• Case report detailing two pregnancies exposed to valproate.
• Clinical and sonographic examination of infants born with suspected fetal valproate syndrome.
• Review of existing literature on valproate teratogenicity.

Main Results:

• Case 1: Infant exposed to valproate and folic acid exhibited typical fetal valproate syndrome features.
• Case 2: Infant exposed to valproate and lamotrigine without folic acid showed prenatally diagnosed spina bifida, Chiari II malformation, clubfeet, and postnatal facial dysmorphism.
• Both cases illustrate the potential for severe congenital anomalies.

Conclusions:

• Valproate is a significant teratogen, posing risks for congenital anomalies.
• Concurrent use of valproate with other antiepileptic drugs may elevate teratogenic risks.
• High-dose folic acid supplementation before and during pregnancy is strongly recommended for women with epilepsy using valproate.