What is a major concern with the use of valproate during pregnancy?

Valproate, commonly used for the treatment of seizure disorders, mood stabilization, and migraine prophylaxis, has significant concerns regarding its use during pregnancy. The major concern specifically relates to its potential detrimental effects on cognitive development in the child. Numerous studies have demonstrated that prenatal exposure to valproate is associated with an increased risk of developmental issues, including cognitive impairment and behavioral problems. These risks stem from the drug's teratogenic effects, which can impact fetal neural development during critical periods of pregnancy.

This concern is particularly important for healthcare professionals to consider when prescribing valproate to women of childbearing age. Monitoring and potentially offering alternative treatments or additional counseling about the risks of valproate during pregnancy are often recommended.

While liver failure, cardiovascular defects, and increased seizure likelihood are concerns associated with valproate treatment, the strongest evidence and emphasis in the context of pregnancy revolves around the cognitive implications for the developing fetus. Thus, the risk of cognitive development issues is the most pressing concern regarding the use of valproate during pregnancy.