Opioids & Topamax Linked to Some Birth Defects

The FDA has upped the risk category for the medication topiramate (Topamax), an antiseizure medication that is also used to help prevent migraine. It is now in pregnancy category D, meaning there is evidence of risk to the fetus. Some IC patients may be taking this medication to prevent migraines, so it may be a concern for IC patients thinking about pregnancy or for those who are pregnant. Because this medication isn't normally prescribed for IC symptoms, we did not include it in our list of medications and their FDA pregnancy risk categories our article "Treatment Choices for Pregnancy and Childbirth" in the most recent issue of the ICA Update.

The article did discuss opioids for pain control, and a new report from the Centers for Disease Control and Prevention (CDC) linking opioid painkillers to birth defects, so if you are thinking about becoming pregnant or are pregnant, you may be concerned. The report linked opioid painkillers taken just before or during the early stages of pregnancy to a modest increased risk of congenital heart defects, spina bifida, and gastroschisis (a type of hernia) and to some increased risk of a few other conditions. The pregnancy risk categories that the FDA assigns to these drugs could change from what we noted in the ICA Update article, so, as the article emphasizes, if you need pain control for IC during pregnancy, get the help of knowledgeable healthcare professionals, such as perinatologists, neonatologists, and lactation consultants, to weigh the risks and benefits of these medications for you. These professionals will be staying abreast of any changes in the FDA risk categories and any other new information about the effects of these medications on you during pregnancy and on your baby-to-be. We know that some IC patients do well during pregnancy because IC symptoms subside or because they can control symptoms with self help, physical therapy, or alternative techniques, so they can avoid even low-risk medications. But others do not do well. For them, the choices are difficult, but they can make the best choices for them by working with healthcare professionals who are experienced in managing pregnancies of women with serious health challenges and the health of their babies.

You can help us learn more about what happens to IC patients during pregnancy and what treatments help you by completing our pregnancy and IC survey at ichelp.org/pregnancysurvey.

Posted March 10, 2011