Valproate exposure during pregnancy is associated with an increased risk of which neural tube defect?

• A. Down syndrome
• B. Neural tube defects such as spina bifida
• C. Congenital heart defects only
• D. No risk

Answer: (B)

Valproate exposure during early pregnancy increases the risk of neural tube defects because neural tube closure occurs very early in gestation and valproate is a teratogen that can disrupt this process, in part by affecting folate metabolism. The most characteristic defect is spina bifida, a neural tube defect where the spinal column fails to close properly. So the statement that neural tube defects such as spina bifida are more likely with valproate exposure correctly captures this risk. While valproate can be associated with other anomalies, Down syndrome is not specifically linked to valproate, and although some congenital heart defects can occur, the notable and defining risk in this context is neural tube defects. There is indeed risk with valproate in pregnancy, so saying there is no risk is incorrect. In clinical practice, women of childbearing potential are advised to avoid valproate when possible and to use alternative anticonvulsants, with appropriate folic acid supplementation if pregnancy occurs or is planned.