Valproate (All indications) updated on 04-22-2025

Table   Graphic     exposition period:

Congenital malformations
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
All congenital malformations (majors, minors, majors and minors, or unspecified)3.06 [2.61, 3.59]27%36 studies149,2798,566low ROB5.57 [4.65; .]
Major congenital malformations2.91 [2.44, 3.48]33%28 studies149,0918,088low ROB5.27 [4.31; .]
Congenital heart defects2.63 [2.04, 3.38]21%15 studies2,2217,175low ROB4.69 [3.50; .]
Hypospadias5.88 [4.60, 7.51]1%10 studies9,5676,978low ROB11.24 [8.68; .]
Limb defects2.43 [1.77, 3.33]0%8 studies1,3343,319not evaluable ROB4.29 [2.94; .]
Spina bifida13.22 [7.24, 24.13]0%7 studies7691,776not evaluable ROB25.93 [13.97; .]
Microcephaly / Small head circumference for gestational age1.18 [0.95, 1.46]0%8 studies134,5924,605not evaluable ROB-
Neural Tube Defects9.34 [4.08, 21.40]0%7 studies523,298not evaluable ROB18.17 [7.62; .]
Oro-facial clefts3.57 [2.43, 5.25]0%7 studies2,8576,825not evaluable ROB6.61 [4.30; .]
Nervous system anomalies3.21 [2.06, 4.98]0%5 studies3743,543not evaluable ROB5.87 [3.54; .]
Polydactyly2.55 [0.48, 13.67]30%5 studies3,0952,112not evaluable ROB-
Urinary malformations1.35 [0.72, 2.52]0%5 studies292,942not evaluable ROB-
Club foot / Talipes equinovarus4.97 [3.12, 7.91]17%3 studies3,8103,641not evaluable ROB9.41 [5.70; .]
Digestive system anomalies1.49 [0.85, 2.60]0%4 studies232,518not evaluable ROB-
Genital anomalies4.68 [3.21, 6.82]0%4 studies1,0451,434not evaluable ROB8.83 [5.87; .]
Minor congenital malformations4.84 [2.06, 11.36]0%4 studies43106not evaluable ROB9.14 [3.54; .]
Cardiac septal defects2.67 [1.74, 4.10]0%2 studies16,5781,030not evaluable ROB4.78 [2.87; .]
Cleft lip with or without cleft palate5.08 [1.87, 13.82]0%3 studies1,6471,204not evaluable ROB9.64 [3.15; .]
Craniosynostosis6.12 [1.26, 29.85]0%2 studies768914not evaluable ROB11.72 [1.82; .]
Cleft palate4.85 [1.37, 17.12]0%2 studies1,181941not evaluable ROB9.16 [2.08; .]
Ano-rectal atresia and stenosis11.70 [3.09, 44.30]-1 study547913not evaluable ROB22.89 [5.63; .]
Atrial septal defect9.00 [5.40, 15.00]-1 study3,283913not evaluable ROB17.49 [10.27; .]
Chromosomal abnormalities2.66 [0.64, 11.11]0%2 studies1887not evaluable ROB-
Ebstein's anomaly20.35 [1.25, 330.13]-1 study50913not evaluable ROB40.20 [1.82; .]
Eye defects0.45 [0.12, 1.72]0%2 studies10309not evaluable ROB-
Eye, ear, face and neck malformations1.13 [0.47, 2.70]0%2 studies2957not evaluable ROB-
Hypoplastic left heart (HLH/HLHS)19.60 [3.59, 107.13]-1 study218913not evaluable ROB38.69 [6.63; .]
Pulmonary valve atresia27.80 [4.99, 154.94]-1 study154913not evaluable ROB55.10 [9.45; .]
Respiratory system anomalies2.45 [0.40, 14.80]43%2 studies2957not evaluable ROB-
Tetralogy of Fallot7.20 [1.33, 38.92]-1 study586913not evaluable ROB13.88 [2.00; .]
Valproate syndrome--0 study-
Ventricular septal defect4.00 [2.08, 7.71]-1 study4,652913not evaluable ROB7.46 [3.57; .]
12 non statistically significant endpoints reported in only one study

Growth parameters and prematurity
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
Preterm (< 37 weeks)1.09 [1.01, 1.18]0%17 studies252,9785,673low ROB1.41 [1.08; .]
Small for gestational age (weight)1.46 [1.08, 1.97]77%11 studies656,0087,191low ROB2.28 [1.38; .]
Low birth weight (< 2500g)1.36 [0.96, 1.94]75%5 studies236,1103,989not evaluable ROB-
Large for gestational age (weight)1.21 [0.74, 1.98]22%3 studies158845not evaluable ROB-
Macrosomia (> 4000g)0.91 [0.55, 1.51]28%3 studies577,4071,059not evaluable ROB-
4 non statistically significant endpoints reported in only one study

Maternal consequences
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
Caesarean0.93 [0.76, 1.14]0%3 studies831926not evaluable ROB-
Assisted deliveries (forceps, vacuum, ...)1.18 [0.73, 1.90]0%2 studies177220not evaluable ROB-
Preeclampsia0.94 [0.77, 1.15]0%3 studies53,7512,428not evaluable ROB-
Maternal consequences (as a whole)1.49 [1.23, 1.82]0%3 studies12,9942,133not evaluable ROB2.35 [1.75; .]
Postpartum hemorrhage1.44 [1.01, 2.06]-1 study319215not evaluable ROB2.23 [1.08; .]
4 non statistically significant endpoints reported in only one study

Neonatal disorders
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
Low Apgar score (< 7) (at 5 min)1.76 [1.06, 2.91]0%7 studies1371,026not evaluable ROB2.91 [1.33; .]
Neonatal medical care1.98 [1.52, 2.59]0%6 studies2,098777not evaluable ROB3.38 [2.41; .]
Low Apgar score (< 7) (at 1 min)2.39 [0.84, 6.81]50%4 studies134673not evaluable ROB-
Neonatal disorders (as a whole)1.05 [0.76, 1.44]35%3 studies225,7531,218not evaluable ROB-
Withdrawal syndrome / Neonatal abstinence syndrome / Poor neonatal adaptation189.00 [2.70, 13229.55]-1 study12not evaluable ROB377.50 [4.84; .]
Feeding difficulty24.38 [1.49, 397.73]0%2 studies23not evaluable ROB48.26 [2.35; .]
Neonatal intracranial hemorrhage15.00 [1.09, 206.94]0%2 studies33not evaluable ROB29.49 [1.40; .]
Very low Apgar score (< 5) (at 1 min)--0 study-
5 non statistically significant endpoints reported in only one study

Long term consequences
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
Child/Infant death (> 28 days of life)3.01 [1.62, 5.60]0%2 studies4,7141,694not evaluable ROB5.47 [2.62; .]
4 non statistically significant endpoints reported in only one study

Intrauterine deaths
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
Intrauterine deaths (as a whole or unspecified)1.42 [0.99, 2.03]33%7 studies4623,046not evaluable ROB-
Early intrauterine deaths (< 22 weeks) / Spontaneous abortions1.04 [0.84, 1.29]0%6 studies3692,499not evaluable ROB-
Late intrauterine deaths (> 22 weeks) / Stillbirths1.83 [1.01, 3.31]0%5 studies422,475not evaluable ROB3.07 [1.14; .]
Elective/induced termination of pregnancy1.83 [0.80, 4.17]0%3 studies211,304not evaluable ROB-
Perinatal death2.16 [0.95, 4.89]0%3 studies271,833not evaluable ROB-
2 non statistically significant endpoints reported in only one study

Neuro-developmental disorders
Adverse outcome OR 95%CII2k No. casesNo. exposedpublication biasROBE-value
Cognitive developmental disorders/delay (> 6 years old)2.69 [1.99, 3.62]40%14 studies24,6334,361low ROB4.81 [3.40; .]
Language disorders/delay2.81 [2.05, 3.83]48%16 studies72,2491,448critical ROB5.06 [3.53; .]
ADHD (Attention deficit hyperactivity disorder): Diagnosis/Risk1.28 [1.13, 1.44]0%12 studies165,0893,988low ROB1.87 [1.50; .]
ASD (Autism spectrum disorder): Diagnosis/Risk2.44 [1.82, 3.27]57%10 studies81,3855,766low ROB4.31 [3.04; .]
ASD (Autism spectrum disorder): Diagnosis2.53 [1.87, 3.42]60%9 studies81,3555,739not evaluable ROB4.49 [3.14; .]
ADHD (Attention deficit hyperactivity disorder): Diagnosis1.26 [1.10, 1.43]0%7 studies153,2293,720not evaluable ROB1.83 [1.44; .]
Neuro-developmental disorders (as a whole)4.09 [3.54, 4.73]0%10 studies10,7773,740low ROB7.64 [6.53; .]
Severe cognitive developmental delay (Mental retardation) (> 6 years old)3.20 [2.45, 4.18]15%8 studies24,6144,141not evaluable ROB5.85 [4.33; .]
Psychomotor developmental disorders/delay2.94 [2.01, 4.29]26%10 studies46513probable ROB5.32 [3.43; .]
Cognitive developmental disorders/delay (3-6 years old)5.06 [2.73, 9.37]52%7 studies3,4661,199not evaluable ROB9.58 [4.90; .]
ADHD (Attention deficit hyperactivity disorder): Risk1.51 [0.99, 2.32]16%7 studies11,883339not evaluable ROB-
Cognitive developmental disorders/delay (< 3 years old)4.09 [2.17, 7.69]53%5 studies64330not evaluable ROB7.65 [3.77; .]
Severe cognitive developmental delay (Mental retardation) (3-6 years old)5.02 [3.12, 8.08]0%4 studies3,4261,101not evaluable ROB9.52 [5.70; .]
ASD (Autism spectrum disorder): Risk1.28 [0.48, 3.42]0%3 studies3779not evaluable ROB-
Childhood autism (F84.0)4.90 [2.32, 10.37]-1 study2,065388not evaluable ROB9.27 [4.06; .]
Learning disorders 1.27 [1.00, 1.61]-1 study232not evaluable ROB1.86 [1.07; .]
1 non statistically significant endpoints reported in only one study

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