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New Study Concludes Phenobarbital Not Safest During Pregnancy

A recent report noted that phenobarbital had a malformation rate of 12.5 percent compared to a 2.2 percentage rate in children whose mothers did not take the drug during pregnancy and did not have epilepsy.

The first report from a pregnancy registry which tracks effects on children whose mothers take antiepileptic drugs during pregnancy found that a drug thought by some to be one of the safest for pregnancy use to be linked to a malformation rate almost six times higher than the rate in the general population.

The first findings from the national Antiepileptic Drug (AED) Pregnancy Registry were presented in Montreal, Canada, at the annual meeting of the Teratology Society on June 25, 2001 and later printed in the journal Teratology.

The report noted that phenobarbital - a drug used for epilepsy since 1912 - had a malformation rate of 12.5 percent compared to a 2.2 percentage rate in children whose mothers did not take the drug during pregnancy and did not have epilepsy.

"It is particularly important for obstetricians to know about the harmful fetal effects," notes Lewis B. Holmes, M.D., the lead investigator in the study.

"Women with epilepsy who become pregnant are sometimes changed to phenobarbital by their physicians because it has been on the market a long time and is perceived to be safer than some of the other AEDs. This practice should stop," Holmes said.

Thinking About Having a Baby?

If you have epilepsy and must take antiepileptic medication, your chances of having a normal baby are at least 90 percent, and more commonly around 94 percent. You may be able to improve these odds by taking a few simple measures that will provide the best possible environment for your developing baby.

1. Plan your pregnancy. Discuss your situation with your neurologist and obstetrician/gynecologist before you become pregnant.

2. Make an appointment with your obstetrician when you first suspect you are pregnant. Keep regular appointments with your obstetrician and neurologist throughout your pregnancy.

3. Take your antiepileptic medication(s) as prescribed by your physician.

4. To the best of your ability, reduce any factors in your life which usually make a seizure more likely to occur.

5. Promptly report all seizures to your neurologist.

6. Get adequate amounts of rest and sleep.

7. Maintain balanced nutrition and proper weight gain. If you have financial problems that make this difficult, consult a federally funded program for mothers and infants. Women, Infants and Children (WIC) is such a program.

8. Before you become pregnant, begin taking folic acid (0.4 mg. per day). Take prenatal vitamins with folic acid regularly throughout your pregnancy. Ask your physician to prescribe Vitamin K1 (Mephyton tablets) during the last few weeks of your pregnancy.

9. Do not smoke. Smoking can harm your baby during all stages of your pregnancy.

10. Avoid consuming any beverages that contain alcohol or caffeine.

11. Do not take any drugs such as marijuana, cocaine and speed. Avoid environmental chemicals like paint, pesticides and oven cleaners.

12. Do not take any prescription or non-prescription (over-the-counter) medication unless it is approved by your physician.

13. For more information on issues that affect women with epilepsy, contact the Epilepsy Foundation's Women and Epilepsy Initiative at (800) EFA-1000.

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