Valproate Teratogenicity — MRCPsych Paper B MCQ

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EasyPerinatal PsychiatryValproate TeratogenicityMRCPsych Paper B

A woman taking valproate 1000 mg daily for epilepsy and bipolar disorder discovers that she is 6 weeks pregnant. Which pattern of fetal and childhood outcomes is most characteristic of in-utero valproate exposure?

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Correct answer: B — Neural tube defects with impaired cognition and autism spectrum disorder

Explanation lettering: D = shown as A · E = shown as C · A = shown as D · C = shown as E

Valproate exposure in pregnancy is characteristically associated with both major congenital malformations and adverse neurodevelopment. Approximately 11% of exposed children have major congenital malformations; neural tube defects such as spina bifida are particularly recognised. Up to 30–40% experience developmental difficulties, including lower intellectual ability, language or memory problems, and increased risks of autism spectrum disorder. Cardiac, renal and limb malformations can also occur with valproate, but the isolated patterns in A, C and D do not capture its characteristic combination of neural tube and neurodevelopmental effects. Pulmonary hypoplasia is not a characteristic valproate effect. The patient requires urgent specialist review and should not stop valproate without specialist advice because abrupt withdrawal may compromise seizure control.

Reference: Depakote 500 mg Tablets, Summary of Product Characteristics, section 4.6: Teratogenicity and developmental effects, revised 2025. https://www.medicines.org.uk/emc/product/6113/smpc