A 28-year-old woman with bipolar disorder on valproate plans a pregnancy. The teratological risk specific to valproate that her neurologist must counsel her about is:
- A Neural tube defects (spina bifida) due to inhibition of folic acid metabolism ✓
- B Cleft palate due to folate antagonism
- C Ebstein's anomaly
- D Persistent pulmonary hypertension of the newborn
Explanation
Valproate is a well-established teratogen with a specific risk for neural tube defects (NTDs), most notably spina bifida, occurring in approximately 1-2% of exposed pregnancies. The mechanism involves inhibition of folate-dependent pathways required for neural tube closure in the first 28 days of gestation. If valproate cannot be avoided, high-dose folic acid (5 mg/day) is recommended pre-conception and throughout the first trimester. Ebstein's anomaly is the classic concern with lithium, and persistent pulmonary hypertension is associated with SSRIs late in pregnancy.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.