Bipolar and valproate: the pregnancy decision — let's get you ready to raise it with your doctor.
For women and people who can become pregnant who are taking valproate (Epilim, Valpro, sodium valproate) for bipolar — or have just been offered it.
This page helps you prepare a conversation with the psychiatrist or GP who looks after your bipolar. It does not tell you to stop, start, switch, or keep taking valproate — that's a decision to make with your prescriber, who knows your history. What it does is put the risk in front of you at a size you can actually picture, so you walk in able to ask about every part of it.
It never diagnoses anything, never names a dose, and never decides for you. Never stop a mood stabiliser without talking to your prescriber first — stopping suddenly can be dangerous in its own right.
If you need to talk to someone now: Lifeline 13 11 14 (24/7, text 0477 13 11 14) · Suicide Call Back Service 1300 659 467 · 13YARN (First Nations) 13 92 76 · 1800RESPECT 1800 737 732 · Poisons Information Centre 13 11 26 · in an emergency call 000.
This tool helps you prepare a conversation — it can't tell what's right for you. If you feel unsafe, or you've stopped your medicine, call your prescriber, 000, or Lifeline 13 11 14 now.
Dr HB Lo
Integrative GP · Bipolar & valproate — the pregnancy decision
What you told me
The number, put in front of you
Every pregnancy carries about a 2–3 in 100 chance of a major physical difference at birth. On valproate, that's about 10 in 100 — and around 30–40 in 100 of children exposed have a learning or developmental difference.
› That's a real, sized decision — and it's yours to raise. Bring this page and ask your psychiatrist or GP to walk through it with you.
Figures from the TGA Valproate safety alert.
100 children — felt at a glance
Shape and position carry the meaning, so it reads the same in black and white.
A physical difference at birth
Background — every pregnancy ~3 in 100
Three of one hundred figures highlighted: the background risk every pregnancy carries.
On valproate ~10 in 100
Ten of one hundred figures highlighted: the risk of a major physical difference at birth on valproate.
Out of 100 children. Numbers from the TGA. Your own risk depends on dose and other factors — ask your doctor what's true for you.
A learning or developmental difference
On valproate ~30–40 in 100
About thirty-five of one hundred figures highlighted: the chance of a learning or developmental difference in children exposed to valproate, the mid-point of thirty to forty in one hundred.
About 35 of 100 shown (the middle of 30–40). Out of 100 children. Numbers from the TGA. Your own risk depends on dose and other factors — ask your doctor what's true for you.
highlighted (a difference) the rest of the 100
The other side — just as real
The other side of this is real too. Untreated bipolar in pregnancy carries its own serious risks — to you and to a baby — and stopping a mood stabiliser suddenly can trigger a relapse. So this is never "valproate bad, stop it." It's "is valproate still the right fit for me, and what are the safer alternatives to weigh up?" That's a conversation to have with your doctor, not a change to make on your own.
There are other mood stabilisers and treatment combinations that carry lower pregnancy risk. Whether any of them suits you is a clinical question for your prescriber — these tools just make sure you know to ask.
General framing consistent with the RANZCP mood disorders guideline and Therapeutic Guidelines (eTG).
Take it with you
Email yourself this one page to bring to your appointment.
You'll get a clean printable: the sized numbers, the two figure arrays, and the questions to ask your psychiatrist or GP — on one page you can hand over.
I'll also send the occasional drhblo email. Unsubscribe anytime.
Your answers stay on your device. If you email the page, only the page is sent — not anything you typed.
This is the general picture. The full bipolar-and-pregnancy decision kit walks you through your alternatives, the contraception-and-planning timeline, and a worksheet to fill in with your psychiatrist.