Q: I am a 25 years old lady, just got married two months back. I have petitmal epilepsy for the last 20 years, for which I take valparin 500 mg two at night and one in the morning. I want to conceive after a year but want to know the side effects of this drug on an unborn fetus and my pregnancy? What are the preventive measures?

A:. Valparin (sodium valproate) if used during pregnancy can cause neural tube (especially spina bifida) defects in the fetus. There are also some reports of multiple fetal defects and rare cases of haemorrhagic syndrome in neonates born to women taking sodium valpraote. The incidence of such malformations is three times more than general population but overall in percentage terms, the figure is not very high. No more than 2% women on sodium valproate are likely to be affected. It is strongly recommended that during pregnancy at 16 weeks gestation, alpha-fetoprotein should be measured and amniocentesis offered for pre-natal diagnosis. More frequent ultrasound tests should also be done. There is some evidence that folic acid 5 mg daily (such as Folet), if started 4 weeks prior to conception, reduces the risk of malformations. Sodium valproate is excreted in milk. Unfortunately, its overall effect on the baby is not known but one should avoid breast-feeding.