Thursday, October 23, 2008

Medication During Pregnancy & Breastfeeding

The most frequent emails that I get from readers are about being on bipolar medication during pregnancy and if they can breastfeed. I have to say that it really is shocking that more information isn't available on the topic.

A few women I've been emailing have been really afraid to take ANYTHING during their pregnancy. I know that I myself wished I could have a drug free pregnancy. However, I know that realistically that would be dangerous for myself and would have been for my baby.

I personally was off my bipolar meds during the first trimester. Prior to getting pregnant I tapered off my all drugs except Lamictal. And I lowered my dose from 400mg of Lamictal to 150mg. Once I had a positive pregnancy test I went from 150 to 0 in 5 days. And remained off of the medication until week 14. When I went back on I did the starter pack all over again starting at 25mg and going to 150mg over several weeks.

An interesting thing happened during week 7 of my pregnancy. I got VERY sick. It was not normal morning sickness. I was throwing up more than 10 times a day. The day before I saw my OB/GYN at the beginning of week 8 I threw up 12 times in one day. Needless to say I was dehydrated and very weak. I lost 5 pounds in one week and had ketones in my urine (which is not good during pregnancy since it means you are burning stored fat). My doctor diagnosed Hyperemesis. And put me on zofran - a strong nausea medicine originally developed for patients undergoing chemotherapy. I would not have been able to continue my pregnancy had I not been on zofran. I would have certainly lost the baby and put myself in dire straights since I was not able to keep even water down.

There is one positive thing about having to go on zofran -- it made it easier to accept that I was going to go back on Lamictal. It helped me to realize that sometimes medication is REALLY a good thing. And that the benefits of many meds outweighs the potential risks.

Some moms have questioned the fact that I am on Lamictal while breastfeeding since it does pass into breastmilk. However, both my psychiatrist and my baby's pediatrician felt the benefits of breastfeeding outweigh the risks associated. I've talked about this is past posts -- but I wanted to mention it again. Pretty much ALL medications pass into breastmilk -- as does environmental toxins like dioxin. The question is really how does a baby respond. If you are considering taking medication while breastfeeding I highly recommend the book Medications and Mother's Milk by Thomas Hale. I also recommend reading KellyMom's article about breastfeeding and medications.

Feel free to email me.
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