Do You Know About Fetal Valproic Acid Syndrome?

Exposure during pregnancy to valproic acid, an anticonvulsant drug, can cause birth defects in the developing fetus.

What is valproic acid?

Valproic acid is an anticonvulsant compound, frequently used in the treatment of epilepsy, migraines, and bipolar disorder.

The mechanism of action of valproic acid consists in increasing the concentration of GABA, a type of neurotransmitter, in the human brain, in addition to causing the blockage of sodium channels, which produces its anticonvulsant effect.

Valproic acid during pregnancy

For several decades, the FDA (Food and Drug Administration) has contraindicated the consumption of valproic acid in pregnant women. This is due to its possible risks to the developing fetus.

Numerous studies have shown that women who consume valproic acid during pregnancy have an increased risk of having a baby with birth defects (caused during pregnancy) or functional abnormalities.

The use of valproic acid is strongly discouraged for the treatment of migraines in pregnant women. However, the issue is not so obvious in the case of treating bipolar disorder or epilepsy. In these cases, an attempt is made to substitute valproate treatment for others that are not harmful to the fetus.

It is important to note that in no case should treatment be terminated without prior medical consultation. Suddenly stopping treatment in pregnant women with seizures can cause seizures that are potentially harmful to both the fetus and the mother.

To avoid these problems, the specialist should carefully analyze the patient’s situation before recommending a treatment with valproic acid. If it is a woman of childbearing age, it is advisable to look for other alternatives.

In these cases, this drug should only be used when there is no other choice. For example, when other medications have not worked or cannot be used for various reasons. However, if it is decided to use it, the patient must be informed of all the risks and the precautions to be taken.

Valproic acid syndrome

The harmful effects of the drug are accentuated if the exposure occurs in the first trimester of pregnancy. This is because it is the moment when the fetus is in full organogenesis.

The teratogenicity of this drug was proposed as early as 1995. Certain aspects such as dose, frequency of administration, metabolism of the mother and fetus, and so on, contribute to this effect.

On the other hand, certain studies show that the epileptic seizures suffered by the mother can have a teratogenic effect on the fetus.

Symptoms

There are cases of mothers who take valproic acid during pregnancy and still give birth to healthy babies. However, the chances of developing birth defects increase with the use of the drug.

Specifically, the chances of producing a neural tube malformation in the fetus, such as spina bifida, increase between 10 and 20 times, when consuming valproate or its derivatives during pregnancy.

On the other hand, there is no single symptomatology in this type of congenital condition. The severity of the abnormalities can vary from almost imperceptible facial features to serious malformations.

Some of the embryopathies that can occur are:

• Characteristic face
• Spina bifida
• Cardiovascular abnormalities
• Genital abnormalities
• Harelip
• Limb malformations
• Developmental delays
• Learning and behavior problems

Treatment

As these are malformations of different degrees, there is no universal treatment for this type of condition.

The measures that are carried out are focused on alleviating or correcting any of the anomalies. In this way , treatment can include:

• Surgery: to correct various malformations, such as cardiac or neural tube abnormalities, cleft lip, sunken palate …

• Speech or physical therapy : it can help the affected child’s learning or improve his locomotion, respectively.

• Extra help at school: to help the child’s learning and intellectual development.

Prevention

The ideal case would be a total suppression of valproic acid treatment in pregnant women. However, this option is not always possible and sometimes it is necessary for the mother to continue with the treatment.

In these cases, it is usually decided to reduce the dose as much as possible, seeking the minimum dose necessary for the mother and shortening the treatment as much as possible.

Another tip is to implement the amount of folic acid consumed by the mother, as this vitamin prevents the fetus from developing spina bifida and can help to counteract the effects of valproic acid to some degree.