Valproic acid is teratogenic for a developing fetus and should be avoided. Valproic acid increases the risk of diminished IQ as well as major congenital malformations including neural tube defects and cardiovascular abnormalities for a developing fetus. If valproic acid treatment is deemed necessary, patients should be counselled regarding contraception and the risks of conception. In this case, the lowest effective dose should be used. For more information:
Bansal R, et al. Maternal and neonatal complications during pregnancy in women with epilepsy. International Journal of Epilepsy. 2016 July;3(2):80-85.
Campbell E, et al. Malformation risks of antiepileptic drug monotherapies in pregnancy: updated results from the UK and Ireland Epilepsy and Pregnancy Registers. J Neurol Neurosurg Psychiatry. 2014 Sep;85(9):1029-34. PMID: 24444855.
Hernández-Díaz S, et al for the North American AED Pregnancy Registry. Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012 May;78(21):1692-9. PMID: 22551726.
Voinescu PE and Pennell PB. Management of epilepsy during pregnancy. Expert Rev Neurother. 2015 Oct;15(10):1171-87. PMID: 26416395.