Fetal Anti-Convulsant Syndrome & Valproate Survey Question Title Question Title * 1. What medical condition do you suffer from? Epilepsy Bipolar Disorder Migraine Unsure Other (please specify) Question Title * 2. How old were you when you first received regular sodium valproate for the condition? 10 yrs or below Between 10 yrs - 15 yrs Between 15 yrs - 20 yrs Over 20 yrs Other (please specify) Question Title * 3. Was Sodium Valproate the first drug your doctor prescribed? Yes No Question Title * 4. Who first prescribed the sodium valproate? Your GP Your Specialist Can't remember Other (please specify) Question Title * 5. Did you understand what the sodium valproate was for and how long you would have to take it for? Question Title * 6. Who continued to prescribe your sodium valproate after the first prescription. GP Neurologist Other (please specify) Question Title * 7. How often did you see them? Question Title * 8. Did you discuss contraception with a healthcare professional? Yes No Can't Remember Question Title * 9. If so with whom and how old were you? Question Title * 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? Question Title * 11. Who told you or where did you read it Question Title * 12. What was your understand of the information you had received? Question Title * 13. How many children do you have? (b) What ages are they? Question Title * 14. Were the pregnancies planned or unplanned Question Title * 15. Did you discuss getting pregnant with your doctor before conceiving? Yes No Unsure Question Title * 16. Were all of your children exposed to the sodium valproate? Yes No Question Title * 17. If not what other medication were they exposed to whilst you were pregnant? Question Title * 18. Have all of your children been adversely affected by sodium valproate during pregnancy? Yes No Unsure Question Title * 19. If not, what medications were the unaffected children exposed to and, if possible what dose. Question Title * 20. If the pregnancies were planned, did you receive counselling on the known risks? Yes No Can't Remember Question Title * 21. If so, who told you what the risks were? Question Title * 22. Were you offered or switched to a different medication other than sodium valproate prior to conceiving? Yes No Unsure Question Title * 23. If so what medication and how soon were you switched- before conception or during pregnancy? Question Title * 24. After being prescribed Valproate for some time, was it ever suggested to you to change your medication before becoming pregnant. Yes No Can't Remember Question Title * 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. Yes No Seizures have never stopped Can't Remember Question Title * 26. Do you take any other regular medications? Please list Question Title * 27. Did you receive advice about taking folic acid? If so, do you remember how much? Question Title * 28. How well was your condition controlled during pregnancy? Well Controlled Uncontrolled Can't Remember Question Title * 29. Did the dose of your medication have to change? Yes No Can't Remember Yes before pregnancy During Pregnancy Question Title * 30. Did you receive any special monitoring of yourself or the baby during pregnancy? Question Title * 31. Did your baby/child receive any special follow up after birth? Question Title * 32. How old was the neonate/ child when the problems were first noticed? And what were the problems? Birth- 6 months 6 month- 12 months 1 yrs - 5yrs 5 yrs- 10 yrs Over Spina Bifida Heart Defects Limb Defects Facial Features Other (please specify) Question Title * 33. What if any of the following Developmental Problems have been notice in your child Motor Control Problems Speech Delay Reduce Cognitive Functioning or IQ Social Difficulties Autistic Spectrum Disorders Behavioural Problems ADHD Other (please specify) Question Title * 34. How old was your child when any specialist referral took place? At Birth 1 - 5 yrs 5 - 10 yrs Over 10 yrs Other (please specify) Question Title * 35. Was it explained to you that your child may be at risk from Fetal Anti-Convulsant Syndrome? Yes No Can't Remember Question Title * 36. Was there any correspondence/letter sent to you from the specialist confirming a diagnosed condition? Yes No Can't Remember Question Title * 37. If you received a letter of diagnosis was any information given to you explaining the diagnosed condition to you? Yes No Can't Remember Question Title * 38. Were you asked to complete a Yellow Form by your Doctor reporting your child’s symptoms? Yes No Can't Remember Question Title * 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. Yes No Not Sure Question Title * 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? Yes No Can't Remember Question Title * 41. Is there anything you would like to add which has not been touched upon. Question Title * 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. FACSA Leaflet INFACT Leaflet Parent Guide Education Guide Question Title * 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. Done