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The ability of a drug to produce structural deformations and functional abnormalities in the developing embryo or the fetus is called teratogenicity, and the drug producing this effect is known as a teratogen. Teratogenic effects include stillbirth, miscarriage, intrauterine growth restriction, and neurocognitive delay. A teratogen may affect the embryo at different stages of development, which is important in determining the type and extent of the damage. During blastocyst formation, the early...
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Valproate and folate: Congenital and developmental risks.

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Sodium valproate (VPA) use in pregnancy poses risks due to interference with folate metabolism. Standard folic acid doses may be insufficient; higher doses and vitamin B12 are recommended for at-risk pregnancies.

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Area of Science:

  • Pharmacology
  • Developmental Biology
  • Nutritional Science

Background:

  • Sodium valproate (VPA) is associated with significant congenital and developmental risks.
  • European guidelines recommend avoiding VPA in pregnancy when alternatives exist.
  • Periconceptual folic acid is known to reduce neural tube defects (NTDs).

Purpose of the Study:

  • To review evidence linking VPA to folate metabolism disruption.
  • To assess VPA's contribution to congenital/developmental issues via folate pathways.
  • To evaluate the adequacy of standard folic acid supplementation against VPA risks.

Main Methods:

  • Literature review of VPA's effects on one-carbon metabolism.
  • Analysis of VPA's interaction with folate receptors in brain and placenta.
  • Examination of genetic polymorphisms in one-carbon metabolism and VPA risk.

Main Results:

  • VPA interferes with one-carbon metabolism, including methylfolate transport.
  • VPA's impact on folate metabolism contributes to observed congenital and developmental problems.
  • Genetic variations in folate metabolism increase vulnerability to VPA-induced risks.

Conclusions:

  • Standard 400µg folic acid may not fully protect against VPA-induced risks.
  • Higher periconceptual folic acid doses (up to 5mg) are proposed for at-risk women.
  • Supplementary vitamin B12 may be beneficial due to common deficiencies and additive risks.