BOF: 2.8
A 24-year-old female who has
primary generalised epilepsy and is on sodium valproate attends the antenatal
clinic for her first consultation. The registrar who sees her rings you up to
ask you for advice regarding the risk of teratogenecity of this drug. You
reply that the baby is at risk of developing:
a)
Atrial septal defect
b)
Cleft lip and palate
c)
Tracheo-oesophageal fistula
d)
Neural tube defects
e)
Renal agenesis
Answer:
d)
There is an increased risk of
teratogenecity associated with the use of antiepileptic drugs. The risk is
reduced if treatment is limited to one drug.
The risk of neural tube defects is
increased with valproate and is also associated with the use of carbamazepine,
oxcarbazepine and phenytoin. Antenatal screening for neural tube defects can
be performed by measuring alpha-foetoprotein levels and second trimester
ultrasound scan.
