A 32-year-old woman with bipolar I disorder is on valproate monotherapy. She plans to become pregnant. Which SPECIFIC teratogenic risk associated with valproate must be MOST prominently discussed during preconception counselling?
- A Ebstein's anomaly
- B Cleft palate
- C Neural tube defects (spina bifida, anencephaly) and neurodevelopmental impairment ✓
- D Limb reduction defects
Explanation
Valproate is the most teratogenic of all mood stabilizers. Its major teratogenic risks include neural tube defects (spina bifida in 1–2%, anencephaly), cardiac defects, craniofacial abnormalities, and critically, long-term neurodevelopmental impairment in the offspring (lower IQ, autism spectrum traits, educational difficulties). The neurodevelopmental risk is dose-dependent. Ebstein's anomaly (tricuspid valve malformation) is the specific risk associated with lithium (though the risk is much lower than originally thought—approximately 1–2 per 1000 exposed). Folic acid supplementation reduces but does not eliminate the NTD risk with valproate.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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