Skip to main content

Table 5 List of frequently asked questions and management options to support shared decision-making regarding valproate use for bipolar disorder before or during pregnancy

From: Sodium valproate in pregnancy: what are the risks and should we use a shared decision-making approach?

Frequently asked questions Continuing the current dose of valproate Lowering the dose of valproate Discontinuing valproate Changing to another medication
What does it involve? No change to medication or dose Over a period of weeks to months, decreasing the amount of valproate Over a period of weeks to months, gradually stopping valproate Switching to a different medication (e.g. lamotrigine or an antipsychotic)
What are the risks to me? Usual side effects of valproate Usual side effects of valproate, potential for relapse Higher risk of relapse (depends on a variety of factors – discuss with your clinician), increased risk of puerperal psychosis Risk of relapse if the other medication is not as effective as valproate; risk of new side effects
What are the risks to my baby? Congenital malformations (see Table 4) long-term developmental disorders (estimated one in 3) Reduced risk of congenital malformations and developmental disorders (risk depends on the dose, discuss with your clinician) Indirect risks, e.g. disinhibition from poorly controlled bipolar disorder (discuss with your clinician) Some medications are much safer for your unborn baby (specifically lamotrigine, some antipsychotics)
What are the benefits? You are less likely to relapse or suffer from puerperal psychosis Your unborn baby will have a lower risk of malformations than if you continue the full dose Your unborn baby will have the same risk of malformations as the general population If you can tolerate the new drug, you are less likely to relapse or suffer from puerperal psychosis; the other medication could have adverse effects
Who would benefit most from this? People with unstable bipolar disorder and frequent relapses who are not controlled on other medication or lower doses of valproate People with bipolar disorder who are not controlled on other medication People who have been stable off valproate and do not wish to take other medications during pregnancy People who are stable on alternatives to valproate