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Epilepsy preconception counselling — DRCOG MCQ

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HardAntenatal CareEpilepsy preconception counsellingDRCOG

A 33-year-old woman with epilepsy attends for preconception counselling. She has been seizure-free for 2 years on sodium valproate. She wants to try for pregnancy in the next few months. What would you advise?

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Correct answer: C — Seek urgent specialist review before conception

Valproate is highly teratogenic and pregnancy planning requires urgent specialist review to consider safer alternatives and optimise seizure control. Stopping abruptly risks maternal seizures, while continuing without review exposes the fetus to avoidable risk. High-dose folic acid is usually recommended preconception for women taking antiseizure medicines. The pearl is that medication optimisation should occur before conception rather than after a positive test.

Reference: MHRA valproate safety advice; NICE NG217; BNF