A 35-year-old man with bipolar I disorder is started on valproate for acute mania. His partner is planning pregnancy. Which major teratogenic risk is specifically associated with first-trimester valproate exposure?
- A Ebstein anomaly
- B Neural tube defects ✓
- C Cleft palate
- D Limb reduction defects
Correct answer: B. Neural tube defects
Explanation
Valproate in the first trimester is strongly associated with neural tube defects, particularly spina bifida, with a risk of approximately 1 to 2 percent. Ebstein anomaly is associated with lithium exposure. Cleft palate has been reported with various anticonvulsants but is not the hallmark valproate defect. Limb reduction defects are classically associated with thalidomide, not valproate.
Reference: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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