Expert: Ivan Goldberg, M.D. - 7/11/2007

Question
I have been diagnosed bipolar for some years now, and though I had
accepted that due to my many medications I'd never be able to have another
baby, I've decided now to see if that is really true.  I'm beginning to think I'm
on stronger meds than I need to be, but I don't want people to think that is
just the bipolar talking.  I don't want to go off my meds for any reason other
than I"d like to have another child.  I'm on Lamactil, Abilify, and Cymbalta.  I
have a rather disinterested and random psychiatrist who doesn't seem to
know much about the newer meds he prescribes.  Is it possible to be bipolar
and have babies or is that irresponsible?  Do you know of any information
resources for bipolar woman who want to have babies?  Thank you.

Leslie

Answer
Hi, Leslie . . .

Mnay women with bipoalre disorder have had children. One thing to remember is that, assuming that htere is no bipolr isorder in the father's imemdiate family, there is approximatelky as 15% chance that the child of as bipoalr mother will have bipolar disorder.

In my private practice I like to maintain people with bipolar disoder on the fewest medications possible. That means that I work very hard to get people off of antipsychotic drugs such as Albiify and even off if antidepressants such as Cymbalta. If possible, people with bipoalr disorder are treated only wigth mood stabilizers sych as Lamictal.

Belwo are some abstracts on what happens when mothers take Lamivctal druing their pregnancies:

1: Neurology. 2005 Mar 22;64(6):955-60.   Related Articles, Links
   Click here to read
   Comment in:

       * Neurology. 2005 Mar 22;64(6):938-9.
       * Neurology. 2006 Jan 10;66(1):153-4; author reply 153-4.


   Lamotrigine and the risk of malformations in pregnancy.

   Cunnington M, Tennis P; International Lamotrigine Pregnancy Registry Scientific Advisory Committee.

   GlaxoSmithKline, Worldwide Epidemiology, Harlow, UK. Marianne.C.Cunnington@gsk.com

   OBJECTIVE: To report the frequency of major malformations in lamotrigine-exposed pregnancies from September 1, 1992, through March 31, 2004, in the International Lamotrigine Pregnancy Registry. METHODS: Health care professionals throughout the world can voluntarily enroll lamotrigine-exposed pregnancies in this observational study. Only pregnancies with unknown outcomes at the time of enrollment were included in the analysis. The percentage of outcomes with major birth defects was calculated as the total number of outcomes with major birth defects divided by the sum of the number of outcomes with major birth defects + the number of live births without defects. RESULTS: Among 414 first-trimester exposures to lamotrigine monotherapy, 12 outcomes with major birth defects were reported (2.9%, 95% CI 1.6% to 5.1%). Among the 88 first-trimester exposures to lamotrigine polytherapy including valproate, 11 outcomes with major birth defects were reported (12.5%; 95% CI 6.7% to 21.7%). Among 182 first-trimester exposures to lamotrigine polytherapy excluding valproate, 5 outcomes with major birth defects were reported (2.7%, 95% CI 1.0% to 6.6%). No distinctive pattern of major birth defects was apparent among the offspring exposed to lamotrigine monotherapy or polytherapy. CONCLUSIONS: The risk of all major birth defects after first-trimester exposure to lamotrigine monotherapy (2.9%) was similar to that in the general population and in other registries enrolling women exposed to antiepileptic monotherapy (3.3% to 4.5%). However, the sample size was too small to detect any but very large increases in specific birth defects.

   PMID: 15781807 [PubMed - indexed for MEDLINE]

2: Acta Neurol Scand. 2004 Jan;109(1):9-13.   Related Articles, Links
   Click here to read
   Epilepsy and pregnancy: lamotrigine as main drug used.

   Sabers A, Dam M, A-Rogvi-Hansen B, Boas J, Sidenius P, Laue Friis M, Alving J, Dahl M, Ankerhus J, Mouritzen Dam A.

   Danish Epilepsy Hospital, Dianalund, Denmark. anns@glostruphosp.kbhamt.dk

   OBJECTIVES: To study the risk of teratogenicity in infants of women with epilepsy. MATERIAL AND METHODS: Prospective data from 1996 to 2000 comprised 147 pregnancies. The most frequent antiepileptic drugs (AEDs) used were lamotrigine (LTG) 35% (n = 51), oxcarbazepine (OXC) 25% (n = 37) and valproate (VPA) 20% (n = 30). Seventy-four per cent (n = 109) received monotherapy. Folic acid supplementation was taken during first trimester by 118 patients (80%). RESULTS: The overall risk of malformations among newborns in the AED-exposed group was 3.1% (n = 4). Two children were born with multiple malformations (VPA monotherapy), two children had ventricular septal defects (one OXC monotherapy, and one OXC and LTG). The risk of malformations was 2.0% in women treated with LTG and 6.7% in women treated with VPA (NS). CONCLUSION: Despite the small number of cases in the study these data indicate that treatment with LTG during pregnancy might be relatively safe. Larger prospective studies are needed to obtain adequate power for statistical analysis.

   PMID: 14653845 [PubMed - indexed for MEDLINE]

3: Epilepsia. 2002 Oct;43(10):1161-7.   Related Articles, Links
   Click here to read
   Preliminary results on pregnancy outcomes in women using lamotrigine.

   Tennis P, Eldridge RR; International Lamotrigine Pregnancy Registry Scientific Advisory Committee.

   Worldwide Epidemiology Department, GlaxoSmithKline, Research Triangle Park, North Carolina 27709, USA. PST49347@gsk.com

   PURPOSE: In 1992, the International Lamotrigine Pregnancy Registry was initiated to enroll prospectively and to monitor pregnancies exposed to lamotrigine (LTG) for the occurrence of major birth defects. This study presents results as of September 2001 on 168 outcomes exposed to LTG monotherapy and 166 outcomes after pregnancies exposed to LTG polytherapy during the first trimester. METHODS: LTG pregnancy exposures are voluntarily reported to the registry by health care providers before they are aware of each pregnancy outcome. Pregnancy-outcome ascertainment is obtained through subsequent follow-up with the reporting health care provider, and each reported birth defect is reviewed by an expert pediatrician. The percentage with major birth defects in pregnancies with known birth defect status was calculated for LTG monotherapy and for polytherapy stratified by trimester of exposure. RESULTS: The registry identified 334 first-trimester LTG pregnancy outcomes exposed to LTG monotherapy or polytherapy during the first trimester and involving either a live birth with or without a major birth defect or an abortion with a major birth defect. After exposure to LTG monotherapy, the percentage with major birth defects exposed to LTG monotherapy was three (1.8%) of 168 [95% confidence interval (CI), 0.5-5.5%]. There were five (10%) major birth defects observed in 50 outcomes after LTG polytherapy involving valproic acid (VPA; 95% CI, 3.7-22.6%) during the first trimester. The observed proportion of major defects after LTG polytherapy without VPA during the first trimester was five (4.3%) of 116 (95% CI, 1.6-10.3%). No specific patterns of major birth defects in any subgroup or within the registry as a whole were observed. CONCLUSIONS: The sample sizes for individual regimens are too small to rule out small increases in frequency of all major birth defects or even large increases in frequency of rare major birth defects. However, the percentage of outcomes with major birth defects after LTG monotherapy in this study and in another similar pregnancy registry in the United Kingdom did not differ from that reported in the recent literature for women with epilepsy receiving antiepileptic drug monotherapy (4%). The frequency of major malformations after exposures of LTG-VPA is higher than that after the LTG monotherapy or LTG polytherapy regimens without VPA. Although there are published data on frequency of major malformations after VPA exposures in pregnancy, between-study differences in methods and source populations and the wide confidence intervals around the estimate for LTG and VPA limit the utility of comparison with such data, and no conclusions are made at this time about this combination. The continued registration of exposed pregnancies to an exposure registry as early as possible in the pregnancy before any knowledge of the outcome, and before any prenatal testing, will enhance the power of such data.

   PMID: 12366730 [PubMed - indexed for MEDLINE]

Best regards . . .
Ivan
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