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Malformations, withdrawal manifestations, and hypoglycaemia after exposure to valproate in utero
Insights
Sodium valproate exposure in pregnancy can lead to fetal valproate syndrome, including major malformations like heart defects. Withdrawal symptoms in newborns were also linked to maternal valproate dosage.
Area of Science:
- Neurology
- Teratology
- Pediatrics
Background:
- Epilepsy treatment during pregnancy poses risks to fetal development.
- Sodium valproate is a common antiepileptic drug with known teratogenic potential.
Purpose of the Study:
- To investigate the effects of prenatal sodium valproate exposure on infants.
- To describe the spectrum of abnormalities and withdrawal symptoms in exposed newborns.
Main Methods:
- A series of 17 infants born to epileptic mothers exposed to sodium valproate during pregnancy were studied.
- Infants were assessed for minor and major malformations, and withdrawal symptoms.
Main Results:
- Five infants exhibited major malformations, termed 'fetal valproate syndrome,' with congenital heart disease being most frequent.
- Nine infants showed withdrawal manifestations, including irritability and seizures, correlated with third-trimester maternal dosage.
- Minor abnormalities and major malformations showed a tendency to correlate with first-trimester maternal dosage.
Conclusions:
- Prenatal sodium valproate exposure is associated with a distinct syndrome of malformations and withdrawal symptoms in infants.
- Dosage and timing of exposure during pregnancy appear to influence the type and severity of adverse outcomes.
Abstract:
An unselected series is presented of 17 infants born to epileptic mothers and exposed to sodium valproate during pregnancy. Nine infants had minor abnormalities and of these infants five also had major malformations, described as the 'fetal valproate syndrome'. The most frequent malformation was congenital heart disease. Nine of the infants had manifestations of withdrawal, such as irritability, jitteriness, abnormalities of tone, seizures, and feeding problems. Four of these infants had an unrelated hypoglycaemia. The frequency of withdrawal symptoms was significantly related to the dose of valproate given to the mothers in the third trimester, and there was a tendency for both the frequency of the minor abnormalities and the major malformations to be related to the valproate dosage in the first trimester.