Depakote use in pregnancy is associated with which neural tube defect?

• A. Spina bifida
• B. Cleft lip
• C. Anencephaly
• D. Gastroschisis

Answer: (A)

Valproate exposure during pregnancy significantly raises the risk of neural tube defects because it disrupts early neural tube closure in weeks 3–4 of gestation, partly by affecting folate metabolism. The most classic neural tube defect linked to Depakote is spina bifida, a failure of the posterior part of the neural tube to close properly, leading to varying degrees of spinal and nerve involvement. While other neural tube defects like anencephaly can also occur with valproate, spina bifida is the association most emphasized in exams. Cleft lip and gastroschisis are not neural tube defects and are not the typical valproate-related risks. Clinically, this underlines the importance of avoiding valproate in pregnancy when possible and considering safer alternatives, with preconception folic acid optimization if exposure occurs.