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New 'pragmatic' advice for nurses around valproate and pregnancy

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New guidance has been produced to support nurses with the “difficult” conversations they may face when discussing pregnancy with women and girls who are prescribed the drug valproate.

The toolkit has been created by 13 national bodies, including the royal colleges of nursing and midwifery, to reflect new regulations around the use of valproate.

“The guidance recognises the extra support needed by women with epilepsy”

Carmel Bagness

Valproate is effective for treating epilepsy and bipolar disorder, but it carries significant risk of birth defects and developmental disorders in children born to women who take the drug in pregnancy.

Last year, the Medicines and Healthcare Products Regulatory Authority (MHRA) said women of childbearing age should not be given valproate unless they were on a pregnancy prevention plan or their epilepsy was not responding to other treatments.

The move, which also reflected European guidance, followed years of campaigning for stronger action by charities and numerous attempts by regulators to beef up guidance and warnings about the potential risks linked to the drug.

The new “pan-college” guidance (see PDF attached) supports clinicians across primary and specialist care with the more challenging issues they might encounter in daily practice by offering “pragmatic” advice. 

Carmel Bagness, professional lead for midwifery and women’s health at the Royal College of Nursing, said: “The RCN is pleased to have played a part in producing this new guidance, which will be welcomed by midwives and nurses, setting out the evidence and pathways of care recommended for girls and women who may be at risk from valproate use pre- conception and during pregnancy. 

Royal College of Nursing

Women facing ‘barriers’ to gynaecological healthcare

Carmel Bagness

“The guidance recognises the extra support needed by women with epilepsy when they become pregnant, and the difficult decisions that sometimes need to be taken,” she said.

“Having clinically-backed information on best practice will be a great help to nursing and midwifery staff,” Ms Bagness added. 

Birte Harlev-Lam, executive director for professional leadership at the Royal College of Midwives, said the guidance was a “great example of the multidisciplinary team working in collaboration for the benefit of the people we care for”.

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