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* 1. What medical condition do you suffer from?


* 2. How old were you when you first received regular sodium valproate for the condition?

* 3. Was Sodium Valproate the first drug your doctor prescribed?

* 4. Who first prescribed the sodium valproate?

* 5. Did you understand what the sodium valproate was for and how long you would have to take it for?

* 6. Who continued to prescribe your sodium valproate after the first prescription.

* 7. How often did you see them?

* 8. Did you discuss contraception with a healthcare professional?

* 9. If so with whom and how old were you?

* 10. How old were you when you became aware about the potential effects of sodium valproate on an unborn child if you were to become pregnant?

* 11. Who told you or where did you read it

* 12. What was your understand of the information you had received?

* 13. How many children do you have? (b) What ages are they?

* 14. Were the pregnancies planned or unplanned

* 15. Did you discuss getting pregnant with your doctor before conceiving?

* 16. Were all of your children exposed to the sodium valproate?

* 17. If not what other medication were they exposed to whilst you were pregnant?

* 18. Have all of your children been adversely affected by sodium valproate during pregnancy?

* 19. If not, what medications were the unaffected children exposed to and, if possible what dose.

* 20. If the pregnancies were planned, did you receive counselling on the known risks?

* 21. If so, who told you what the risks were?

* 22. Were you offered or switched to a different medication other than sodium valproate prior to conceiving?

* 23. If so what medication and how soon were you switched- before conception or during pregnancy?

* 24. After being prescribed Valproate for some time, was it ever suggested to you to change your medication before becoming pregnant.

* 25. Was it ever suggested to you, after taking Valproate for a lengthy period and having no seizures, to reduce or even stop the medication.

* 26. Do you take any other regular medications? Please list

* 27. Did you receive advice about taking folic acid? If so, do you remember how much?

* 28. How well was your condition controlled during pregnancy?

* 29. Did the dose of your medication have to change?

* 30. Did you receive any special monitoring of yourself or the baby during pregnancy?

* 31. Did your baby/child receive any special follow up after birth?

* 32. How old was the neonate/ child when the problems were first noticed? And what were the problems?

* 33. What if any of the following Developmental Problems have been notice in your child

* 34. How old was your child when any specialist referral took place?

* 35. Was it explained to you that your child may be at risk from Fetal Anti-Convulsant Syndrome?

* 36. Was there any correspondence/letter sent to you from the specialist confirming a diagnosed condition?

* 37. If you received a letter of diagnosis was any information given to you explaining the diagnosed condition to you?

* 38. Were you asked to complete a Yellow Form by your Doctor reporting your child’s symptoms?

* 39. If you did not complete the Yellow Form, to your knowledge, did your doctor complete one reporting your child being affected by your medication.

* 40. Were you made aware of, by your doctor, specialist and/or GP, any support groups and/or Organisations, locally or nationally, who could help and advice on Valproate in pregnancy?

* 41. Is there anything you would like to add which has not been touched upon.

* 42. If YOU have any questions about Fetal Anti-Convulsant Syndrome or Valproate in Pregnancy please contact either FACSA or INFACT ON 01253 799161, OR e mail at office.infactfacsa@yahoo.com or you can find us on FACEBOOK & Twitter (Emma4facs).

We offer a range of information about the condition. Please tick if you would like to receive any of the following and give your detail in the next question box.

* 43. Thank you for your time in completing this survey. Please tell us if you would like to be involved in any other of our surveys in the future. If so please give your answer below and add an e mail address if you wish to take part.

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