Preconception counselling with valproate — DFSRH MCQ
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Correct answer: A — Advise effective contraception and urgent specialist preconception review before stopping contraception
Valproate is highly teratogenic, so effective contraception should continue while urgent specialist preconception planning reviews safer treatment options. Stopping contraception before medication review risks an exposed pregnancy. UPA is not ongoing contraception, folic acid does not remove teratogenic risk, and sterilisation is disproportionate for future pregnancy planning. The pearl is to treat preconception counselling as risk reduction before conception, not after a positive test.
Reference: MHRA Valproate Pregnancy Prevention Programme; UKMEC 2025