Carbamazepine Use During Pregnancy

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Presentation transcript:

Carbamazepine Use During Pregnancy Flavio Guzmán, MD

Overview Risks of teratogenicity Risks of neonatal toxicity and developmental abnormalities Treatment recommendations

Teratogenicity risks

Congenital malformations Overall risk estimated between 3 to 6% Review of 6 registry-based studies (epilepsy) Lower risk than valproate, still significant Try to avoid it during pregnancy Association between maternal daily dose and risk of fetal malformations Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

Congenital malformations Overall risk estimated between 3 to 6% Review of 6 registry-based studies (epilepsy) Lower risk than valproate, still significant Try to avoid it during pregnancy Association between maternal daily dose and risk of fetal malformations Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

Common malformations Neural tube anomalies Spina bifida Images: CDC (CC license) Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

Common malformations Neural tube anomalies Spina bifida Craniofacial defects (short nose, epicanthic folds, hypertelorism) Cardiovascular malformations, hypospadias Images: CDC (CC license) Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

Neonatal effects

Neonatal effects Neonatal effects Transient hepatotoxicity Microcephaly Growth retardation Vitamin K deficiency Coagulopathy Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

Neurodevelopmental effects

Neurodevelopmental effects Uncertainty Some studies have shown variable degrees of developmental delay Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

Recommendations

Vitamin K (to reduce coagulopathy) Recommendations Avoid during pregnancy if possible Use 20 mg during pregnancy 1 mg IM to the newborn Vitamin K (to reduce coagulopathy) At preconception and during the first 3 months of pregnancy Folic acid 4-5 mg/day Chisolm, M. S., & Payne, J. L. (2016). Management of psychotropic drugs during pregnancy. BMJ, 352, h5918.

Monitoring Ultrasound at 16-18 weeks Consider fetal echocardiography at 16-20 weeks Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

End of presentation