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While not all anticonvulsant drugs have been studied in pregnancy, a number of adverse effects have been identified in infants and children of women treated with these medications during pregnancy.
Major malformations, midface and digit hypoplasia, microcephaly, growth restriction, and deficits in IQ are sometimes seen, although the pattern of abnormalities and specific effects vary for individual drugs.
While some infants exposed to an anticonvulsant drug in utero have abnormalities, others do not. Genetic differences in the fetal response to medications probably play a role.
It has been hypothesized that maternal epilepsy might cause fetal abnormalities independent of any drug effect, but several studies suggest that anticonvulsant treatments are usually responsible.
However, it seems likely that repeated or prolonged maternal seizures, such as occur in status epilepticus, can be devastating to the fetus. Preconception care provides an opportunity to choose a plan of anticonvulsant treatment that will pose the least risk to the fetus while appropriately managing maternal symptoms.
New data about the effects on the fetus of anticonvulsant medications are emerging steadily, and the latest information should always be sought. The treatment plan must be individualized for each woman in collaboration with her neurologist, psychiatrist, or other specialist.
In addition, preconception care offers the opportunity to consider whether additional measures, such as the use of a higher daily dose of folic acid, might be beneficial. Only limited and somewhat conflicting information is available about whether periconceptional supplementation with folic acid at levels higher than 0.
Managing maternal conditions with intermittent symptoms—asthma Asthma is a chronic condition with intermittent symptoms, for which treatment during pregnancy is essential to safeguard the health and well-being of both the mother and fetus.
Abrupt cessation or undertreatment of asthma during pregnancy can endanger both. Studies suggest that maternal asthma during pregnancy can increase the risk for perinatal mortality, preeclampsia, preterm delivery, and low birth weight.
In the extreme, maternal hypoxia can result in decreased umbilical blood flow, increased systemic and pulmonary vascular resistance in the fetus, and decreased fetal cardiac output.
Additional pathophysiologic mechanisms that could contribute to these adverse outcomes include hyperactivity of uterine and bronchial smooth muscle and the release of bioactive mediators during symptomatic asthma. For these reasons, it is considered safer for pregnant women to be treated with asthma medications than to experience asthma symptoms and exacerbations.
A variety of medications are available to treat acute and chronic asthma. They include beta 2-agonoists, corticosteroids, cromolyn, leukotriene modifiers, theophylline, and anticholinergics.
These drugs have different mechanisms of action and thus potentially different effects on the fetus.
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One comparative retrospective study assessed the effect of invasive acne scar treatment and laser hair removal in a group of 55 patients on a combination of topical therapy and isotretinoin 0.