Highlights of this issue

Abstract

The risks associated with using sodium valproate in pregnancy have been well established for over a decade. Indeed, some campaigners have argued that evidence for its teratogenicity was available from animal trials as early as 1974. These risks are now more clearly defined: 40% of babies exposed to valproate in utero are at risk of developmental disorders and 10% are at risk of birth defects. These harms are therefore predictable and to a large extent could be preventable. In their editorial – kicking off the December issues of BJPsych – Howes et al (pp. 711–713) recognise the incredible importance of sodium valproate in the treatment of epilepsy, mania and bipolar depression, as well as for relapse prevention in bipolar affective disorder. However, they call for greater action in advising women of childbearing ability about the teratogenic harms. In particular, they point to several initiatives – such as the ‘prevent’ programme – that have been implemented over the past 5 years to either reduce prescriptions of valproate in women capable of becoming pregnant or that attempt to educate women about the harms and provide reliable contraception to these women. Yet, in a recent audit of mental health trusts, only a quarter of women aged under 55 years who were prescribed valproate and for whom pregnancy was biologically possible were offered the full benefits of the ‘prevent’ programme. With the extensive guidance and information now available, there seems to be little excuse not to adequately counsel and support women considering a valproate prescription. This editorial presents a serious call to arms for clinicians to consider their own prescribing practices, ensure they are aware of regulatory requirements around valproate prescription and always address the risk of harm in anyone for whom pregnancy is biologically possible.