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6 weeks 2 days pregnant, on depakote ER 750mg till 4th week of pregnancy. Possibility of birth defects?

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I am currently six weeks and two days pregnant. Unaware of potential birth defects, I was on 750 mg of Depakote ER up until I was four weeks pregnant. Am I at still at high risk for birth defects? My fetal specialist said I am at decreased risk because I stopped the medicine when I did. But my psychiatrist and another obgyn said otherwise. Who is right?
Posted Thu, 26 Apr 2012 in Pregnancy
Answered by Dr. Minoo Bhagia 8 hours later

Thanks for your query.

4 weeks pregnancy means you have an embryo, amniotic sac and a yolk sac. Valproic acid during early pregnancy is associated with neural tube defects like spina bifida. The chances is unpredictable though. Females taking antiepileptic drugs sometimes deliver normal healthy babies.

I suggest you to go for other screening measures. These test do have false positive results too. The tests are:

1. In the first trimester- Free beta subunit of hCG and PAPP-A ( pregnancy associated plasma proteins ). There can be abnormally high levels of free beta hCG and low PAPP-A. The test should be combined with nuchal translucency means water under the skin of the neck.
2. In second trimester total hCG, unconjugated oestriol and alpha fetoproteins are done to detect the defect. This test is simply termed as triple test. Second level ultrasound is done in second trimester.

So there is a risk in your case. But what is the percentage? - I simply can not predict without these tests.

Women having more than one drug are more prone to develop birth defects than single drug.

Doctor's usually prescribe high doses of folic acid to prevent the birth defects. You may discuss with your healthcare provider who can prescribe folic acid.

Since you stopped the medicine at 4 weeks, you should go for the investigations and continue till 11 weeks for the clear picture.

Rest is your decision.

You may discuss about these again with your gynecologist and get the tests and medications prescribed to you through them.

Hope I have answered your query. Should you have any more concerns, I will be available to answer them.

God bless you!!!


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