Fetal valproate syndrome

Fetal valproate syndrome (FVS) is a rare condition that may occur when a baby is exposed to valproic acid during pregnancy. Valproic acid is a medication that is often used to treat epilepsy, bipolar disorder, and migraines. Many babies who are exposed to this medication are born healthy with normal growth and development; however, studies have found that women who take valproic acid have a greater chance of having a baby with a major birth defect or other health problems. Signs and symptoms of FVS vary from person to person and may include characteristic facial features, neural tube defects, congenital heart defects, cleft lip and/or palate, genital abnormalities, limb malformations, and developmental delay. Treatment is based on the signs and symptoms present.^[1][2][3]

Many babies who are exposed to valproic acid during pregnancy are born healthy and do not have fetal valproate syndrome. However, studies have found that women who take valproic acid have a greater chance of having a baby with a major birth defect. When present, the signs and symptoms of FVS can vary significantly from person to person and may include:^[1][2][3]

• Characteristic facial features (high, broad forehead; epicanthal folds; thin, arched, wide-spaced eyebrows; a small, upturned nose with a wide bridge; a long, shallow philtrum; and a thick lower lip. These features may become less prominent over time.)
• Neural tube defects (such as an opening in the back known as spina bifida)
• Congenital heart defects
• Cleft lip and/or palate
• Genital abnormalities (undescendent testes, or the opening of the urethra in the underside of the penis (hypospadia)
• Limb malformations
• Developmental delay, attention deficit disorder, learning disabilities and communication problems

FVS is often suspected in an infant with characteristic signs and symptoms whose mother reports taking valproic acid during the pregnancy. Because FVS is considered a diagnosis of exclusion, other conditions that are associated with similar signs and symptoms must be ruled out prior to making the diagnosis.^[1]

The treatment of FVS is based on the signs and symptoms present in the person, and often involves a team of medical specialists, and may include:^[1][2][3] 

• Surgery (birth defects such as neural tube defects, congenital heart defects, and cleft lip and/or palate may be present in people with FVS and may require surgery shortly after birth)
• Long-term follow-up of the child (to detect and treat early potential behavioral or developmental issues)
• Early speech therapy, occupational therapy, and/or physical therapy
• Extra assistance at school