Valproate-induced biochemical abnormalities in pregnancy corrected by vitamins: A case report

Purpose: Valproate (VPA) is a teratogenic anticonvulsant (AED), but vitamin supplementation has been suggested to limit the effect of VPA on the fetus . Maternal urinary metabolites were monitored to assess the metabolic effec ts of VPA before and after vitamin supplementation. Methods: A pregnant woman with epilepsy receiving VPA and ethosuximide (ESM ) was given high-dose multivitamins from 13 to 28 weeks' gestation. Materna l urinary metabolites were measured throughout the pregnancy by gas chromat ography/mass spectrometry. Results: Before multivitamin supplementation began, the patient bad signifi cantly increased excretion rates of alpha-ketoglutarate, beta-lactate, pyru vate, lactate, methylmalonate, and other metabolites compared with normal p regnant women. During multivitamin supplementation, many previously increas ed excretion rates decreased significantly. Fetal head growth was normal up to 30 weeks, but then lagged. Bitemporal narrowing was noted at birth. Conclusions: VPA may cause metabolic abnormalities in pregnancy. Many bioch emical abnormalities attributable to VPA in this patient were corrected wit h high-dose multivitamin supplementation. The specific oration between bioc hemical abnormalities and VPA teratogenesis remains to be determined.