Valproate Teratogenic Risk Percentage — MRCPsych Paper B MCQ
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Correct answer: E — Approximately 10%
Valproate monotherapy during pregnancy is associated with major congenital malformations in approximately 11% of exposed children, making B the best answer. This risk is dose-dependent, and no risk-free threshold has been established. Approximately 2–3% is the background major-malformation risk in the general population, so A is too low. The 30–40% figure in D refers to neurodevelopmental disorders or developmental delay following in-utero valproate exposure, not congenital malformations. The estimates in C and E substantially overstate the usual malformation risk. In UK psychiatric practice, valproate is contraindicated for treating bipolar disorder during pregnancy and is subject to stringent reproductive-risk safeguards.
Reference: Electronic Medicines Compendium, Depakote 500 mg Tablets Summary of Product Characteristics, section 4.6: Congenital malformations from in-utero exposure, updated 18 August 2025. https://www.medicines.org.uk/emc/product/6113/smpc