Fetal Valproate Syndrome - Still a Problem Today!

Abstract:

:Introduction Fetal exposition to valproate can lead to a cluster of facial dysmorphism, congenital anomalies and neurodevelopmental retardation. Case Report In this report we describe 2 cases of fetal valproate syndrome. In the first case, the gravida had a valproate medication before and during pregnancy with additional folic acid. She delivered a male premature infant at 25+2 weeks of gestation due to preterm labor and rupture of the membranes. Physical examination showed even in the premature infant typical signs of fetal valproate syndrome with trigonocephaly, epicanthal folds, broad root of the nose, low-set ears, thin upper lip and anteverted nares. In the second case, the gravida was under antiepileptic therapy with valproate and lamotrigine before and during pregnancy without any prophylaxis with folic acid. Sonographic examination during pregnancy diagnosed a spina bifida, Chiari II malformation and clubfeet. A female newborn was delivered at 39+4 weeks of gestation. Besides the prenatally detected anomalies, facial dysmorphism including microcephaly, low-set ears, thin upper lip and shallow philtrum were seen after birth. Conclusion Valproate, a widely used anticonvulsant medication, is known for its teratogenic effects. The risk of congenital anomalies is even higher in combination with other antiepileptic drugs. Therefore, the avoidance of valproate or at least supplementation with a high dose prophylactic folic acid before and during pregnancy is highly recommended for women with epilepsy. :Einleitung Fetale Exposition gegenüber Valproat kann zu einem Symptomkomplex aus fazialen Dysmorphiezeichen, kongenitalen Fehlbildungen und Entwicklungsverzögerung führen. Fallbericht In diesem Artikel beschreiben wir 2 Fälle mit fetalem Valproatsyndrom. Im ersten Fall hat die Schwangere vor und während der Schwangerschaft Valproat in Kombination mit Folsäure eingenommen. Aufgrund vorzeitiger Wehentätigkeit und einer Plazentalösung wurde Ihr Kind als Frühgeborenes von 25+2 Schwangerschaftswochen geboren. Die klinische Untersuchung postnatal zeigte selbst bei dem Extremfrühgeborenen typische Zeichen eines fetalen Valproatsyndroms mit Trigonocephalus, Epikanthus, breitem Nasenrücken, tiefem Ohransatz, schmaler Oberlippe und antevertierten Nasenlöchern. Im zweiten Fall war die Schwangere vor und während der Schwangerschaft unter antiepileptischer Therapie mit Valproat und Lamotrigin ohne Folsäureprophylaxe. Die sonographische Untersuchung während der Schwangerschaft diagnostizierte eine Spina bifida, Chiari II Malformation und Klumpfüße. Mit 39+4 Schwangerschaftswochen wurde ein weibliches Neugeborenes geboren. Neben den bereits pränatal diagnostizierten Anomalien fielen postnatal eine Mikrocepahlie sowie faziale Dysmorphiezeichen wie tiefsitzender Ohransatz, schmales Oberlippenrot und ein flaches Philtrum auf. Schlussfolgerung Valproat, ein vielfach eingesetztes Antikonvulsivum, ist bekannt für seine teratogenen Effekte. Das Risiko kongenitaler Fehlbildungen vergrößert sich in Kombination mit anderen Antiepileptika. Deshalb empfehlen wir eindringlich die Vermeidung von Valproat bei Frauen mit Epilepsie und Kinderwunsch oder zumindest die Einnahme einer hochdosierten Folsäureprophylaxe.

authors

Wiedemann K,Stüber T,Rehn M,Frieauff E

doi

10.1055/s-0043-107619

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

243-246

issue

5

eissn

0948-2393

issn

1439-1651

journal_volume

221

pub_type

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