Pregnancy

Question 1

Best treatment for Myasthenia in pregnancy

Answer 1

Pyridostigmine (azathioprine: category D) (Methotrexate: category X) (Prednisone: Category C, small increase in cleft palate in first trimester, Late = PROM at high doses)

Question 2

Relative risk factors for Spina Bifida:

Affected sibling:

Maternal valrpoate or carabamazepine intake:

Inadequate folic acid intake

Maternal hyperthermia

maternal obesity

Answer 2

1. Affected sibling: 30 fold increase
2. Maternal VPA / CBZ intake: 10-20 fold increase
3. Inadequate folic acid supplementation: 2-8 fold
4. Maternal hyperthermia: 2 fold, 3 if exposure to hot tubs, saunas, electric blankets
5. Marternal obseity (BMI >29): 2 fold increase

Question 3

AED least likely to be affected by pregnancy

Answer 3

Carbamazepine

Question 4

Antiseizure medications during pregnancy

Answer 4

Decreased levels of:

Phenytoin
Valproic acid
lamotrigine
oxcarbazepine