Valproate teratogenicity — MRCPsych Paper A MCQ

Instant feedback + full explanation. One question, done properly.

EasyPsychopharmacologyValproate teratogenicityMRCPsych Paper A

A 22-year-old woman with bipolar disorder was started on sodium valproate abroad. She asks why exposure to valproate during pregnancy is of particular concern. Which fetal outcome is most characteristically associated with valproate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Neural tube defects and adverse neurodevelopmental outcomes

Valproate exposure in pregnancy is strongly associated with major congenital malformations, particularly neural tube defects such as spina bifida, and with adverse neurodevelopmental outcomes including developmental delay, reduced cognitive ability and increased rates of autism spectrum disorder. UK safety information estimates major malformations in around 11% and developmental problems in approximately 30–40% of exposed children. Ebstein anomaly and neonatal hypothyroidism are classically associated with lithium exposure. Premature ductus arteriosus closure and oligohydramnios are risks of NSAID exposure later in pregnancy. Persistent pulmonary hypertension and neonatal adaptation symptoms are associated with late-pregnancy SSRI exposure, while neonatal extrapyramidal or withdrawal symptoms can occur following antipsychotic exposure.

Reference: Medicines and Healthcare products Regulatory Agency. Valproate – reproductive risks, updated 23 September 2025. https://www.gov.uk/guidance/valproate-reproductive-risks