A 27-year-old woman with focal epilepsy is planning pregnancy. She is currently well controlled. Which antiseizure medication carries the highest risk of major congenital malformations and cognitive impairment in the fetus and should be avoided?
- A Lamotrigine
- B Valproate ✓
- C Levetiracetam
- D Oxcarbazepine
Correct answer: B. Valproate
Explanation
Sodium valproate carries the highest teratogenic risk among antiseizure drugs, with neural tube defects and a dose-dependent risk of major malformations around 10 percent, plus documented impairment of childhood cognition including lower verbal IQ. Lamotrigine and levetiracetam have among the lowest observed malformation rates and are the preferred choices in women planning pregnancy. Oxcarbazepine is intermediate but far safer than valproate.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.