Which mood stabilizer is associated with neural tube defects in pregnancy?

Which mood stabilizer is associated with neural tube defects in pregnancy?

• A. Depakote
• B. Lamictal
• C. Lithium
• D. Tegretol

Answer: (A)

Valproate, known by the brand Depakote, is strongly teratogenic and is most famously linked to neural tube defects when used in the first trimester. Neural tube closure occurs very early in pregnancy, and exposure to valproate during this critical window disrupts this process, increasing the risk of defects such as spina bifida and anencephaly. Because of this, valproate is avoided in women who are pregnant or may become pregnant, and alternatives are preferred for mood stabilization in those patients. Other mood stabilizers have different risk profiles—for example, lithium is associated more with heart defects like Ebstein’s anomaly, and lamotrigine and carbamazepine carry their own, less pronounced, but distinct teratogenic risks. The strongest and most well-established link to neural tube defects among these medications is with Depakote, making it the correct association.

Valproate, known by the brand Depakote, is strongly teratogenic and is most famously linked to neural tube defects when used in the first trimester. Neural tube closure occurs very early in pregnancy, and exposure to valproate during this critical window disrupts this process, increasing the risk of defects such as spina bifida and anencephaly. Because of this, valproate is avoided in women who are pregnant or may become pregnant, and alternatives are preferred for mood stabilization in those patients. Other mood stabilizers have different risk profiles—for example, lithium is associated more with heart defects like Ebstein’s anomaly, and lamotrigine and carbamazepine carry their own, less pronounced, but distinct teratogenic risks. The strongest and most well-established link to neural tube defects among these medications is with Depakote, making it the correct association.