Nearly one in five valproic acid (VPA) prescriptions filled between 2017 and 2022 went to women of childbearing age, most commonly for mood disorders and migraine, according to a study in the
Journal of Clinical Psychiatry. Further, a sizeable majority of these women receiving VPA weren’t using prescription contraceptives.
Why It’s Important
VPA is highly effective for epilepsy, migraine, and bipolar disorder, but it also carries one of the highest risks of any drug for causing congenital malformations and neurodevelopmental disorders in children exposed to the drug in utero. In 2013, the Food and Drug Administration issued a communication stating that VPA should not be prescribed to pregnant women for migraine prophylaxis due to decreased IQ scores seen in exposed children.
By the Numbers
- According to Medical Expenditure Panel Survey (MEPS) data, there were 29,754,849 VPA prescriptions from 2017-2022, of which 18% went to women ages 12 to 49.
- Of the estimated 153,129 women of reproductive age who filled a prescription for VPA, just 14% had documented use of contraception.
- Most VPA prescriptions to women aged 12-49 were for migraine (27%), followed by bipolar disorder (25%) and convulsions or epilepsy (21%).
- In contrast, among women ages 50+, most VPA prescriptions were for bipolar disorder (30%), followed by a depressive episode (20%).
- Total VPA prescribing declined by half over the study period, from 5,945,500 in 2017 to 2,969,230 in 2022.
The Other Side
MEPS data relies on self-reports, which may be prone to recall bias. Also, the MEPS does not include over-the-counter contraceptives or implants like an intrauterine device, so the contraception rate among women taking VPA may be slightly higher.
What’s Next
“It is crucial to ensure that all clinicians are trained/prompted to inform patients about the teratogenic risks of VPA use, since it influences reproductive planning decisions,” the study authors wrote. They added that future research is needed on “development and implementation of interventions to reduce VPA use in women of reproductive age and/or encourage contraceptive use.”
Related Article
Source
Nina Vadiei et al. Valproic acid use trends, patterns, and predictors in females of reproductive age in the United States. Published December 15, 2025. Doi: 10.4088/JCP.25m16009
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