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Q: Meds & 1st Trimester
Dr. Phelps
I have been taking Depakote 750 mgs and Zoloft 50 mgs for about 7 months.
I just found out that I am pregnant. It is still really early. I am
probably about 3 weeks pregnant. My psychiatrist told me to stop
everything and not to worry about birth defects because it is so early. I
am still really concerned especially after reading tons of articles on the risks
in the first trimester. Is the fetus at less risk if you stop early in the
first trimester?
Hello Ms. P'
[Replied directly by email]
Just read your inquiry tonight. I don't know the timing, but if you haven't
passed day 25 yet, you could call your doc' or his on-call colleague and get a 1
mg dose of folate daily for a few days. Your doc' is probably right, the timing
is in your favor, and even if it wasn't, the rate of problems is pretty darn
low. But just so you can do everything you can possibly do to stack the odds in
your favor, at this point the folate is a small step but one that you can
actually do something about. If you're past day 27 it's moot but remember, it's
not that big a deal, I'm not writing to say "quick, go do this, you really
need to, etc." The rate of neural tube problems, which is what this is all
about at this stage of pregnancy, is 1-2% for kids exposed during the closure
phase of the neural tube development. Closure takes place between day 25 and day
27, thus the advice above. Remember, the risk to kids for fetal malformations is
about 2% in women not taking medications; and the risk with Depakote all the way
through pregnancy is just barely higher than that, with a large number of
problems emerging in later phases of pregnancy (i.e. problems you'll not be at
risk for because of having stopped already). If you're willing to consider an
abortion were there a sure malformation, you can consider prenatal testing:
"Suggested prenatal diagnostic testing includes a maternal serum
alpha-fetoprotein test at 15 to 20 weeks of gestation and an anatomic ultrasound
at 16 to 18 weeks of gestation. This detects neural tube defects with more than
95 percent sensitivity."
Dr. Phelps
Published November, 2002 |