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Bartels, K., Karhausen, J., Clambey, E

5.4 Use in Women of Childbearing Potential Because of the risk to the fetus of decreased IQ, neurodevelopmental disorders, and major congenital malformations (including neural tube defects), which may occur very early in pregnancy, valproate should not be administered to a woman of childbearing potential unless other medications have failed to provide adequate symptom control or are otherwise unacceptable

Notably, a large portion of use is do-it-yourself regimen change