INTRODUCTION The perinatal period is associated with up to 2/3 relapses in untreated bipolar disorder (BD), with important consequences on the clinical BD outcome and on fetal and child development. Valproate (VPA), one of the most effective treatments in BD, is associated with the highest risk of serious neurodevelopmental disorders in exposed children. This has brought to tightened restrictions to its use by regulatory agencies and clinical guidelines. METHODS A panel of experts on the pharmacological treatment of BD conducted a non-systematic review of the scientific literature and clinical guidelines until March 2019, and provided specific evidence-based and experience-based clinical recommendations for VPA switching/discontinuation in BD women of childbearing potential. RESULTS After the review of the evidence in a face-to-face meeting, the panel concluded that several clinical criteria need to be considered to make a clinical decision about VPA discontinuation and switch. The plateau cross-taper switch may be preferred. Abrupt switching may bear augmented risk of relapse CONCLUSIONS: BD childbearing women treated with VPA must be managed on a personalized basis according to the clinical situation. It is mandatory to stop VPA during pregnancy. The duration of the discontinuation/switch process depends on different clinical variables. Lithium, lamotrigine, quetiapine, olanzapine or aripiprazole are good options for switch in stable BD patients in planned/unplanned pregnancy. In unstable BD patients planning pregnancy, stability is paramount. Prevention of post-partum episodes requires reinstatement of effective treatment before or after birth (in the case of VPA). VPA is still an option in the post-partum period and beyond.

中文翻译：

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育龄期双相情感障碍女性丙戊酸盐治疗的专家建议

引言 在未经治疗的双相情感障碍 (BD) 中，围产期与高达 2/3 的复发相关，对临床 BD 结局以及胎儿和儿童发育具有重要影响。丙戊酸盐 (VPA) 是 BD 中最有效的治疗方法之一，与暴露的儿童发生严重神经发育障碍的风险最高有关。这导致监管机构和临床指南对其使用的限制更加严格。方法 BD 药物治疗专家小组对截至 2019 年 3 月的科学文献和临床指南进行了非系统性审查，并为 BD 育龄妇女的 VPA 转换/停用提供了具体的循证和基于经验的临床建议潜在的。结果 在面对面的会议中审查证据后，专家组得出结论，需要考虑几个临床标准才能做出关于 VPA 停用和转换的临床决定。平台交叉锥度开关可能是优选的。突然转换可能会增加复发风险 结论：接受 VPA 治疗的 BD 育龄妇女必须根据临床情况进行个性化管理。怀孕期间必须停用 VPA。停药/转换过程的持续时间取决于不同的临床变量。锂、拉莫三嗪、喹硫平、奥氮平或阿立哌唑是计划/计划外妊娠稳定 BD 患者转换的良好选择。在计划怀孕的不稳定 BD 患者中，稳定性是最重要的。预防产后发作需要在产前或产后恢复有效治疗（在 VPA 的情况下）。