Valproate is particularly associated with neural tube defects; what is the clinical implication?

• A. Neural tube defects
• B. Hypertension
• C. Diabetes
• D. Obesity

Answer: (A)

Valproate exposure during early pregnancy is a known teratogen that significantly increases the risk of neural tube defects such as spina bifida and anencephaly. Clinically, this means women who could become pregnant should avoid valproate if possible, or engage in thorough preconception planning with a switch to safer alternatives when feasible, and use the lowest effective dose if the drug is absolutely necessary. If valproate must be continued, counsel on high-dose folic acid supplementation (typically around 4 mg daily) before conception and through the first trimester, and arrange early fetal ultrasound screening to assess neural tube development. The main implication is the heightened risk of neural tube closure defects from early drug exposure, which guides medication choices and preconception/early pregnancy management. Other conditions like hypertension, diabetes, or obesity are not the specific fetal risk associated with valproate in this context.