Valproate Teratogenicity — MRCPsych Paper B MCQ

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EasyPerinatal PsychiatryValproate TeratogenicityMRCPsych Paper B

Which medication used in the treatment of bipolar disorder is associated with major congenital malformations in approximately 11% of babies exposed during pregnancy and neurodevelopmental problems in approximately 30–40% of exposed children?

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Correct answer: D — Sodium valproate

Sodium valproate is the correct answer. Maternal valproate exposure during pregnancy is associated with major congenital malformations in around 11% of babies and neurodevelopmental problems in approximately 30–40% of exposed children. Reported malformations include neural-tube, craniofacial, cardiac, limb and urogenital abnormalities. In UK psychiatric practice, valproate must not be prescribed to a woman or girl able to have children unless the Pregnancy Prevention Programme requirements are met. Lithium carries a smaller absolute teratogenic risk, particularly of cardiac malformations. Carbamazepine is also teratogenic but does not carry the characteristic risk magnitude stated. Lamotrigine generally has a more favourable reproductive safety profile, while quetiapine is not associated with this valproate-specific pattern of fetal harm.

Reference: Medicines and Healthcare products Regulatory Agency. Valproate – reproductive risks, section 'The risks of women taking valproate during pregnancy'. Updated 2025. https://www.gov.uk/guidance/valproate-reproductive-risks