Unplanned pregnancies and prenatal exposure to sodium valproate

Abstract

Sodium Valproate (VPA) is a widely used antiepileptic drug with well-documented teratogenic potential. In utero exposure has been associated with a broad spectrum of congenital anomalies involving the central nervous system, cardiovascular system, skeletal structures, and urogenital tract, as well as neurodevelopmental disorders, including autism spectrum disorder. This study reports a case series of three Tunisian patients aged 2 months to 3 years, born from unplanned pregnancies with in utero exposure to VPA prescribed for maternal epilepsy. The aim of this study is to describe the clinical, phenotypic, and developmental features of these patients and to emphasize the importance of preconception counseling in women with epilepsy. VPA was administered as monotherapy in two cases and in combination with carbamazepine in one case, without periconceptional folic acid supplementation. All patients presented with global developmental delay and characteristic craniofacial dysmorphism. Congenital heart defects were identified in two patients. These findings highlight the increased risk of congenital malformations associated with prenatal exposure to VPA, whether used alone or in combination therapy. The observed features are consistent with the established teratogenic profile of VPA reported in both experimental and clinical studies. This underscores the critical importance of preconception counseling and optimized therapeutic management in women with epilepsy. A multidisciplinary approach including obstetricians, neurologists, pediatricians and midwives is essential to reduce fetal morbidity in our clinical setting.