Clinical and neurodevelopmental findings in four children (two sibling pairs) exposed in utero to valproic acid are reported from the Departments of Paediatrics and Human Genetics, University of Witaterstrand, Johannesburg, South Africa. Three were globally developmentally delayed with marked speech disability, characteristic dysmorphic features, and one with autism. The fourth child had dysmorphism and a learning disability. 
COMMENT. Future children could be at increased risk of fetal valproate syndrome if valproate is continued during pregnancy. The drug itself, the dosage, the genetic susceptibility, and other environmental factors are involved in the etiology of drug-related birth defects. In addition to adverse effects on the fetus, valproate is reported to cause reproductive disorders, including polycystic ovaries and hyperandrogenism, in women with epilepsy (see Ped Neur Briefs Dec 1993).