Attitudes toward sodium valproate use, withdrawal, and counseling in people of reproductive potential: A scoping review

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Regulatory restrictions and evolving clinical guidelines have aimed to reduce sodium valproate use in people of reproductive potential over the past decade due to its teratogenic risk. While clinical evidence and policy responses are well established, stakeholder perspectives remain less explored. This scoping review synthesizes the existing evidence on the attitudes of patients, caregivers and healthcare professionals regarding sodium valproate use, withdrawal and counseling in females of childbearing age. This scoping review, conducted according to JBI Methodology for a Scoping Review and registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/HK7QN), analyzed studies which directly reported on, or measured, the attitudes of patients, caregivers and/or healthcare professionals regarding the use of sodium valproate for epilepsy in females. A structured search across four databases (EMBASE, Web of Science, MEDLINE, PsycINFO) and the gray literature was performed. A thematic synthesis of data was conducted to identify important themes and concepts. A total of 22 studies including 14 peer-reviewed articles and 8 gray literature sources met the inclusion criteria, including only 2 qualitative studies. Most literature focused on patient and caregiver perspectives (n = 15), with fewer addressing healthcare professional views (n = 7). Methodology incorporating interviews (n = 2) or free-text survey responses (n = 3) was uncommon. Across the studies, three key themes emerged: (i) patient disempowerment due to limited knowledge and suboptimal counseling and risk communication; (ii) the influence of maternal identity formation on attitudes, behaviors and decision-making when navigating sodium valproate use; and (iii) concerns regarding regulatory responses, such as pregnancy prevention programs, particularly around implementation challenges, perceived paternalism and lack of individualized care. Published evidence on stakeholder attitudes toward sodium valproate use in people of reproductive potential remains limited. The existing literature highlights gaps in awareness, counseling, and patient-centered delivery of pregnancy prevention programs. Future research should prioritize qualitative studies to better understand stakeholder attitudes and experiences to inform future guidelines and clinical practice. PLAIN LANGUAGE SUMMARY: Sodium valproate is an antiseizure medication that can harm an unborn baby when used during pregnancy. National and international programs have been introduced to reduce its use among people who could become pregnant. This review explored the perspectives of patients, caregivers and healthcare providers regarding sodium valproate use and withdrawal. Key themes included experiences of disempowerment relating to risk communication, the influence of maternal identity on treatment decisions and concerns about regulatory approaches. These findings highlight factors contributing to challenges with pregnancy prevention programs, in particular gaps in shared decision-making, communication and patient-centered care.