Topiramate (Topamax) Associated with an Increased Risk of Oral Clefts
Topiramate (marketed as a Topamax), in addition to its use for the treatment of epilepsy, is now being prescribed to reproductive aged women for a broad spectrum of indications, including migraine headaches, weight control, and mood stabilization. Limited information is available on its reproductive safety; however, the preliminary data we do have raises some concerns regarding the use of topiramate in pregnancy.
PPHN and SSRIs: Yet Another Study
A few weeks after the FDA called into question the association between SSRI exposure and persistent pulmonary hypertension of the newborn or PPHN, BMJ published another article supporting an increased risk of PPHN among infants exposed to SSRIs in utero.
Depression in Women: Is There a Role for Vitamin D?
Sources of vitamin D include sunlight (ultraviolet B, or UVB, rays), dietary intake, and supplements. Sunlight is the main source of human vitamin D. Vitamin D refers to different forms of a steroid hormone. Vitamin D3 (also called 1, 25-dihydroxycholecalciferol or calcitriol) is produced by the body when ultraviolet light (in the form of UV B) interacts with 7-dehydrocholesterol . Vitamin D3 is thought to be more potent than vitamin D2, with D3 and D2 being the two forms of vitamin D contained in supplements.
SSRIs and PPHN: The FDA Revises Its Warning
In 2006, Chambers and colleagues published an article in the New England Journal of Medicine linking SSRI use during late pregnancy to an increased risk of persistent pulmonary hypertension in the newborn (PPHN). Based on these findings, the “Usage in Pregnancy” section on the labels for SRRI antidepressants was updated to include the following warning: “Infants exposed to SSRIs in late pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (PPHN).”
Post Traumatic Stress Disorder and Pregnancy
Understanding posttraumatic stress disorder (PTSD) during pregnancy is important given that PTSD is relatively common and persistent in nature. PTSD will occur in approximately 10% of women in their lifetime, with one-third of episodes lasting more than five years. Given the relatively high prevalence of PTSD in young women and the chronic nature of the illness, many women may experience PTSD symptoms during pregnancy.
Clinical Case: Would You Use Gabapentin (Neurontin) During Pregnancy?
Ms. P is a 32-year-old married woman who presented for consultation regarding the use of medication during pregnancy. She had been taking fluoxetine (Prozac) 20 mg for many years for the treatment of recurrent major depression and generalized anxiety. In addition, she was prescribed gabapentin (Neurontin) for sleep.