1. Carbamazepine Use During Pregnancy
Flavio Guzmán, MD

2. Overview Risks of teratogenicity
Risks of neonatal toxicity and developmental abnormalities
Treatment recommendations

3. Teratogenicity risks

4. Congenital malformations
Overall risk estimated between 3 to 6%
Review of 6 registry-based studies (epilepsy)
Lower risk than valproate, still significant
Try to avoid it during pregnancy
Association between maternal daily dose and risk of fetal malformations
Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

5. Congenital malformations
Overall risk estimated between 3 to 6%
Review of 6 registry-based studies (epilepsy)
Lower risk than valproate, still significant
Try to avoid it during pregnancy
Association between maternal daily dose and risk of fetal malformations
Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

6. Common malformations Neural tube anomalies Spina bifida
Images: CDC (CC license)
Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

7. Common malformations Neural tube anomalies Spina bifida
Craniofacial defects (short nose, epicanthic folds, hypertelorism)
Cardiovascular malformations, hypospadias
Images: CDC (CC license)
Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

8. Neonatal effects

9. Neonatal effects Neonatal effects Transient hepatotoxicity
Microcephaly
Growth retardation
Vitamin K deficiency
Coagulopathy
Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

10. Neurodevelopmental effects

11. Neurodevelopmental effects
Uncertainty
Some studies have shown variable degrees of developmental delay
Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

12. Recommendations

13. Vitamin K (to reduce coagulopathy)
Recommendations
Avoid during pregnancy if possible
Use
20 mg during pregnancy
1 mg IM to the newborn
Vitamin K (to reduce coagulopathy)
At preconception and during the first 3 months of pregnancy
Folic acid 4-5 mg/day
Chisolm, M. S., & Payne, J. L. (2016). Management of psychotropic drugs during pregnancy. BMJ, 352, h5918.

14. Monitoring Ultrasound at 16-18 weeks
Consider fetal echocardiography at weeks
Epstein, R., Moore, K. M., Bobo, W (2015). Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges. Drug, healthcare and patient safety

15. End of presentation