Valproate Teratogenicity — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementValproate TeratogenicityORE Part 1

A 40-year-old woman taking sodium valproate for epilepsy tells her dentist that she is planning pregnancy. Which advice about her medication is most appropriate?

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Reveal the answer and explanation

Correct answer: A — Arrange specialist review of antiseizure treatment before conception

Explanation lettering: D = shown as B · E = shown as D · B = shown as E

Answer: A. Sodium valproate has substantial fetal risk, and UK guidance requires women with epilepsy who are planning pregnancy to be referred to an epilepsy specialist team to review antiseizure medication options before conception. Valproate use in women able to have children is subject to strict MHRA Pregnancy Prevention Programme requirements and is reserved for situations where alternatives are unsuitable. She must not stop valproate independently, because uncontrolled epilepsy and seizures may result. Therefore B is unsafe. C is false because valproate is associated with congenital malformations and neurodevelopmental harm. Folic acid is relevant to pre-conception care but does not remove valproate's reproductive risk or justify continuing it without specialist review, so D is inadequate. E incorrectly focuses on dental care rather than urgent medication counselling and specialist referral.

Reference: National Institute for Health and Care Excellence. NG217: Epilepsies in children, young people and adults, section 4.5.2–4.5.5, last updated 30 January 2025. https://www.nice.org.uk/guidance/ng217/chapter/principles-of-treatment-safety-monitoring-and-withdrawal