A morphologic basis postulated for valproic acid's embryotoxic action in rats.

A tentative 3 phase sequence of pathogenesis is proposed for the embryotoxic action of valproic acid (800 mg/kg) administered orally to rats on day 13 of pregnancy. This is based on histopathological changes in the extraembryonic and embryonic tissues which occurred in the absence of any biologically significant effect on maternal homeostasis. Major events in the first, decidual (or maternal) phase are cells lining the maternal sinusoids in the decidua basalis are necrosed, desquamated, and washed away by the arterial circulation through the afferent channels. The necrosed cells, with their walls still intact, occlude the lumen of these arterial channels at the point of their entry into the giant cell-trophospongial zone. The channel occlusions cause ischemia and homeostasis of the maternal circulation in the labyrinth by reducing the rate of inflow of maternal blood. The embolic occlusion of maternal arterial channels apparently results in a long-term reduction in the number and size of maternal channels that supply arterial blood to the labyrinth. In the second or placental phase, the parenchyma of the labyrinth and connective tissue in the chorionic plate and umbilical cord, which have been deprived of nutrition and oxygen by the ischemia and stasis of maternal blood in the labyrinth, undergo degenerative changes. In the third or embryonic phase, a pleiotropic karyorrhexis in the embryo, initiated as early as 4 h postdosing, appeared aggravated, presumably by the preceding labyrinthine degeneration of the placental phase. The valproic acid-induced embryotoxicity thus seemed to result from a combination of maternal, placental, and embryonic changes.