Valproic acid prescription trends among females of childbearing age in Estonia: A 14-year nationwide prescription database study

Valproic acid (VPA), also known as valproate, is among the most frequently prescribed antiepileptic drugs (AEDs). A major safety issue with VPA is its teratogenicity. Data from several pregnancy registries have consistently shown that the offspring of mothers who use VPA during pregnancy are at greater risk of major congenital malformations [1,2]. Reports have described impaired intellectual and behavioural development in children exposed to VPA in utero [3]. In response to these data, the European Medicines Agency (EMA) strengthened its warnings for VPA use by females in 2014, recommending that, when VPA treatment is necessary, women with childbearing potential should use effective contraception and VPA treatment should be supervised by a physician experienced in treating these conditions.