Fetal valproate spectrum disorder (fetal valproate syndrome)

Page most recently updated 7 September 2026

This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.

Fetal valproate spectrum disorder (fetal valproate syndrome) is a disorder resulting from prenatal exposure to valproate, affecting neurodevelopment and potentially multiple organ systems. A distinctive presentation may include characteristic facial features and congenital abnormalities such as neural tube defects, cardiac defects, and radial ray abnormalities.

It can present with psychiatric features such as ADHD, autism spectrum disorder (ASD), anxiety, depression, behavioural difficulties, and problems with attention, executive functioning, and social communication. These neuropsychiatric manifestations can persist into adulthood, and mood and cognitive difficulties have been described in adults with FVSD.

From a morphologic lens perspective, other features include (but are not limited to):

  • Prominent forehead

  • Prominent metopic ridge

  • Midface retrusion

  • Telecanthus

  • Epicanthus

  • Depressed nasal bridge

  • Broad nasal bridge

  • Short nose

  • Long philtrum

  • Narrow mouth

Other characteristic features include intellectual or developmental disability, speech and language impairment, learning difficulties, memory impairment, and motor or coordination difficulties. Other congenital abnormalities may include cleft palate, additional limb abnormalities, genitourinary abnormalities, and ophthalmological abnormalities.

Early diagnosis is important to identify neurodevelopmental, psychiatric, congenital, and sensory complications; provide appropriate developmental, educational, behavioural, and psychosocial support; and allow surveillance and management of potentially significant medical complications.

Selected references and further reading — Morphologic lens

Jones KL, Jones MC, del Campo M. Smith's recognizable patterns of human malformation. 8th ed. Philadelphia: Elsevier; 2021.

Reardon W. The bedside dysmorphologist: a guide to identifying and assessing congenital malformations. 2nd ed. Oxford: Oxford University Press; 2016.

Allanson JE, Biesecker LG, Carey JC, Hennekam RCM. Elements of morphology: introduction. Am J Med Genet A. 2009;149A(1):2-5. doi:10.1002/ajmg.a.32601.

Hennekam RCM, Biesecker LG, Allanson JE, Hall JG, Opitz JM, Temple IK, Carey JC; Elements of Morphology Consortium. Elements of morphology: general terms for congenital anomalies. Am J Med Genet A. 2013;161A(11):2726-2733. doi:10.1002/ajmg.a.36249.