Q:  Daughter's Meds & her Unborn Child

My daughter has been diagnosed with Bipolar disorder, about a year ago.  She is 16 1/2 and has just found out that she is pregnant.  She is on Depadote, Paxil, Zyprexa, Adderal and Zyrtec (for allegies).  We carry a family history of cleft palate.  She doesn't function well at all when not taking meds.  What, in general, would be the outcome for this unborn child--medically speaking?

Dear Carol -- 
Depakote is associated with about a 1-in-100 chance of something called spina bifida.  Paxil has not clearly been associated with birth defects.  Zyprexa hasn't been around long enough to know much for sure.  Adderall -- basically amphetamines -- have not been studied in humans, according to a little search just now; but use late in pregnancy is associated with premature delivery (that's probably street amphetamine use) so that will be an issue later.  Zyrtec has no specific information on birth defects, and it's on a list of "safe" medications on this OB-Gyn site (at the very bottom of the long list).  

I would presume by the time the pregnancy was discovered that your daughter was beyond 4 weeks pregnant so adding folate, a simple vitamin, often recommended when women are going to attempt pregnancy while taking Depakote, is probably moot now.  There is an option of an ultrasound examination of the spinal cord, which can detect abnormalities associated with Depakote (remember the odds are roughly 99 to 1 against this problem).  

Dr. Phelps

Published February, 2003