Valproate is a treatment for epilepsy and bipolar disorder and is prescribed to thousands of women. Since its introduction in 1974, the product information for doctors has included a warning about the possible risk of birth defects. As the risks to unborn children have been increasingly understood, the warnings have been strengthened.
MHRA has worked with industry, healthcare professionals and patient groups on a toolkit to ensure female patients are better informed about the risks of taking valproate medicines during pregnancy.
The risk of developmental disorders is up to 4 in 10 and the risk of birth defects is approximately 1 in 10.
In women who take valproate while pregnant, around 1 in 10 babies will have a birth defect.
Birth defects seen when mothers take valproate during pregnancy include:
- spina bifida (where the bones of the spine do not develop properly)
- facial and skull malformations (including cleft lip and palate, where the upper lip or facial bones are split)
- malformations of the limbs, heart, kidney, urinary tract and sexual organs.
In women who take valproate while pregnant, about 3–4 children in every 10 may have developmental problems. The long-term effects are not known.
The effects on development can include:
- being late in learning to walk and talk
- lower intelligence than other children of the same age
- poor speech and language skills
- memory problems.
Children exposed to valproate in the womb are more likely to have autism or autistic spectrum disorders. There is also some evidence children may be more likely to be at risk of developing symptoms of attention deficit hyperactivity disorder (ADHD).
Valproate should not be used in female children, in female adolescents, in women of childbearing potential and in pregnant women unless other treatments are ineffective or not tolerated. Women of childbearing potential must use effective contraception during treatment.
No-one should stop taking valproate without discussing it first with their doctor and the benefits of valproate treatment must be carefully balanced against the risks.
If valproate is the only option, women of childbearing age should be given effective contraception. Women taking valproate must have regular reviews of their treatment.
View the checklist
View the patient card
View the brochure for patients and in Welsh
View the brochure for healthcare professionals
View the Patient Information Leaflets
View the MHRA statement welcoming the launch of the toolkit.
Discussing Valproate - a video for GPs, pharmacists and other healthcare professionals, on our latest advice about the toolkit and discussing risk of valproate medicine during pregnancy with their patients (this video was developed by MHRA in collaboration with the Royal College of General Practitioners and the Royal Pharmaceutical Society)::
Patient support networks
If you have questions or concerns about the risks associated with valproate and pregnancy, please speak to your doctor, pharmacist or other healthcare professional.
You can also contact a patient support network such as:
Bipolar UK 0333 323 3880
Epilepsy Action 0808 800 5050
Epilepsy Society 01494 601 400
Mind 0300 123 3393
If you are taking valproate and think you might be pregnant or know you are pregnant, contact your doctor at once so that you can talk through your options.
If you have experienced any side effects to this medicine you can report these to MHRA using the Yellow Card Scheme.
If you or your child has been affected by valproate medicines, you can also contact a support network such as:
OACS 020 8386 9271
INFACT/FACSA 01253 799161