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Valproate in Females — RACP Paediatrics MCQ

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HardNeurology & DevelopmentValproate in FemalesRACP Paediatrics

A 14-year-old with known epilepsy is considering pregnancy in the future. She is on sodium valproate. What counselling should be provided?

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Correct answer: D — Valproate has the highest risk of teratogenicity and neurodevelopmental impairment among ASMs and should be avoided in females of childbearing potential

Valproate carries the highest teratogenic risk of all ASMs (major malformations 10%, neural tube defects 1-2%) and causes neurodevelopmental impairment (reduced IQ by 8-10 points, increased ASD risk). All females of childbearing potential should be on alternative ASMs where possible. High-dose folate (5 mg) should be prescribed pre-conceptionally.

Reference: AMH Children's Dosing Companion – 2024 – Sodium Valproate