Question about lamitrogine on conception and fetus

baly3225

My husband and I are planning to start trying in the near future but we have a major issue ahead of us. I'm on 300mg of lamitrogine (lamictal) and know that there are some risks of birth defects while pregnant and taking this medicine. I was put on the medicine after being diagnosed with BPD. My options are to try to go off the medicine altogether, be closely monitored, and see someone three times a week to help with my mood fluctuation. My other option is to stay on the medicine throughout my pregnancy and while breastfeeding. I'm really afraid though that the fetus will be exposed causing a birth defect. I've read a bunch of horror stories when women have tried to come off of the medicine and it was basically physically and mentally impossible. I have also read many success stories of women on low doses who gave birth to happy and healthy babies. My OB/GYN and Psych have told me that they would recommend I stay on because if I'm mentally unstable during the pregnancy then that will do more harm for my baby than being on the medicine. I just want to know that I will have a healthy baby if I stay on the medicine or if there are other options. Is there anyone who is in this situation or was and can give me more information than my drs or studies that I have read?!

DebateThis

You need to trust your doctors on this one. It's pregnancy Category C so in your case I'd absolutely stay on it - benefits outweigh the risks.

ETA: I found this on PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22594849

Lamotrigine is a sodium-channel-modulating, antiepileptic drug (AED), which was approved in the USA in 1994 for use in partial-onset seizures. It was ultimately approved for monotherapy in 1998. Lamotrigine has gained widespread use in the USA as both an immediate and an extended-release agent. Lamotrigine is effective against a broad spectrum of seizure types and has a favorable metabolic profile, with few but significant drug interactions. Pregnancy registries in several countries have demonstrated that AED use in women with epilepsy is associated with an increased risk of fetal malformations, if the infant is exposed during the period of organogenesis. In addition, new evidence demonstrates that AEDs may affect the intellectual development of a child, as measured up until the age of 3 years. This information has made the choice of an anticonvulsant for a woman who might become pregnant significantly more important. Pregnancy registries have consistently demonstrated lamotrigine to be among the safest medications for a developing fetus, both in terms of fetal malformations and postpartum cognitive development. These findings make lamotrigine probably the first choice of AED for women wishing to become pregnant and for whom the medication is appropriate.

annibes

I'm sorry- this must be a very difficult decision to make. My thought on it is that the doctors are aware of your history and the risks to a pregnancy and so they're then best sources to help you make your decision. I have no advice on the best course of action but I am happy to offer support and wish you the best!

orangecrush32

I'd take your dr's advice and stay on the med. They know what they're talking about.

Ashleypixie

Obviously you should be asking your precribing dr these questions. I take it for epilepsy so I don't know how it's different for you other than that you are on a lower dosage. There is a very slight risk for cleft palate and even slighter for club foot, but the chances are extremely low. You might be surprised as I was when they want to INCREASE the dose. Stopping is incredibly dangerous, so do not do anything without speaking to your doctor first. I ran out once and had a massive seizure because of it and flatlined in an ambulance-so do not do anything without your drs recommendation!!! By the way, our baby is healthy and doing fine. We've been through several ultrasounds and every test imaginable with a specialist as well as my neurologist and my levels are constantly monitored. I would not worry about the effect on your baby. But see your doc. We are not medical professionals, but I hope this helped. Good luck!!

thejucheidea

I also take Lamictal for bipolar disorder -- my psychiatrist said that the biggest issue seen was cleft palate, but she said that as long as I was taking enough folic acid, that shouldn't be a problem, and you're supposed to take folic acid when taking Lamictal anyway, so I've been doing that for years.

She did lower my dose to 100 mg q hs from 200 mg q hs however and gave me 300 mg q am Wellbutrin to cover depressive times, as I'm type 2 and therefore more prone to depressive episodes. Lamictal is definitely one of the safer drugs during pregnancy, but I'm wanting to breastfeed also and it's more likely to be expressed at higher concentrations in breastmilk than Wellbutrin is.

I haven't spoken at length with my gynecologist yet (my preconception appointment is 1/27), but that's just what I have so far from my psychiatrist.

baly3225

Thank you so much for the information and support.  I am going to talk with my dr about decreasing my dosage instead of completely going off of it. An option would be 200mg instead of 300.  Obviously, my number one priority is keeping a fetus healthy and that's why I'm going to see if I can just lower my dosage.  I am also going to see someone at a maternal-fetal medicine unit in the next month or two to discuss options as well.  I figure it can't hurt to get as much information as possible and another opinion.  My psych never mentioned anything about folic acid which I'm somewhat upset about but I am planning on starting to take that now that I know this information.

thejucheidea - Breastfeeding is a definite for me as well but I know that I am at a high risk for PPD.  If you can, please let me know how it goes...any more insight you could give me is always greatly appreciated!