Meds & 1st Trimester
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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


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