Which adverse effect of valproate requires particular caution in women of childbearing potential?

• A. Hepatotoxicity
• B. Kidney stone formation
• C. Teratogenicity
• D. Hypothyroidism

Answer: (C)

The main issue here is the teratogenic risk of valproate. Valproate exposure during pregnancy can cause major birth defects, most notably neural tube defects such as spina bifida, and can also contribute to other congenital malformations and potential cognitive impacts. Because these harms can occur very early in pregnancy, even before a woman knows she’s pregnant, teratogenicity is the adverse effect that requires special caution for women who could become pregnant.

In clinical practice, this means prioritizing pregnancy planning and contraception discussions, using the lowest effective dose if valproate must be continued, and considering alternative medications with safer reproductive profiles when possible. If a pregnancy occurs or is planned, folic acid supplementation before conception is advised to help reduce risk, though it does not eliminate it.