Question

Ingestion of what product by the mother may cause the infant to have cleft palate, spina bifida and an (ASD doubtful)?

• A. Isotretinoin
• B. Valproate
• C. Phenytoin
• D. Carbamazepine

Hint:

This antiepileptic has the highest neural tube defect risk in pregnancy.

Answer 1

The Correct Option is B

This question is describing a set of birth defects and asking which drug taken by the mother causes this exact pattern.

1. Isotretinoin: Causes its own recognized pattern of defects, such as heart defects, ear and facial defects, and central nervous system defects, but spina bifida is not its typical feature, so it does not fit well here.
2. Valproate: Known to cause the highest rate of neural tube defects among antiepileptic drugs, giving spina bifida. It also causes cleft palate and cardiac defects such as ASD. This matches all three features in the question.
3. Phenytoin: Linked with fetal hydantoin syndrome, mostly limb and nail changes with some facial change, but spina bifida is not the hallmark finding.
4. Carbamazepine: Carries some neural tube defect risk but at a much lower rate than valproate, and is not the best fit for this full combination.

Since the pattern of spina bifida, cleft palate, and a possible ASD together matches fetal valproate syndrome most closely, valproate is the correct answer.

Let's summarize:

• Valproate has the strongest known link to neural tube defects among antiepileptics.
• It also adds craniofacial and cardiac defects, matching the full pattern described.

The correct answer is valproate.