Pregnancy & Concerns re: Depakote
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Q:  Pregnancy & Concerns re: Depakote

I just found out I was pregnant yesterday.  My last period started six weeks ago.  I'm discontinuing the depakote (was taking 500 mg. once a day) immediately, but I'm really scared damage may have already occurred. Do you have a rough idea of what the odds are of birth defects?  In the cases you've seen like this, does the baby usually turn out free of birth defects, if the mother quits as soon as she knows she's pregnant?

Thanks, Panicking Lisa

Dear Lisa -- 
By the time you read this, I hope you've learned a lot more and have a strategy for coping with the worry.  For example, I hope you've learned somewhere faster than me that the current estimate of abnormalities in kids exposed to Depakote, at doses generally double to triple what you were taking, throughout the first trimester, is between 2 and 5%
Altshuler, 2004

What happens to these odds if you quit at 4 weeks of pregnancy?  Probably about the same, had you been taking full dose Depakote (e.g. 1000 at least, 1500 mg is closer to the average dose).  That's because the neural tube issue is over by 4 weeks of pregnancy; it's a very early development as the fetus starts to grow.  

Since you were taking less, the risk may be lower in your case.  It may relate more to how long you were taking Depakote, because the problem seems to be associated with reduced folate (a common vitamin) levels.  But there are no numbers to quote, that I know of, regarding how much the risk changes by dose or by length of exposure. However, there is enough behind this logic that Dr. Altshuler and colleages stated "using the lowest available dosage may decrease the risk" in reference above. 

So by now I hope that you've either settled on an estimate and are working on coming to terms with that risk, or have been looking for and have started working with a good therapist who knows how to use "cognitive and behavioral" techniques to help you cope with a worry that probably keeps popping into your mind.  One of the simplest versions of that approach is to switch the numbers from "two to 5 percent" to their inverse statistic:  the odds of your baby coming out fine are between 95 and 98 times out of a hundred, or perhaps a bit higher due to the low dose thing.  Same information, different emphasis.  Obvious approach, I know; people have probably been urging you to think that way.  It's just one of several techniques a good therapist could help make sure you're using, if you're still struggling with this issue -- which would be very understandable, of course.  Most mothers would worry.  You just need a strategy if your worry seems excessive.  Good luck to you.  

Dr. Phelps 

Published November, 2004


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