Anytime a decision is made to keep a pregnant woman on a chronic medication, their health care provider has first asked themselves who is
MOST likely to be harmed? The mother by going OFF the medication or the baby by having mom stay ON the medication? Also, the health care provider doesn't usually make that decision totally on their own. Usually there will be communication between the obstetrician and the mom's neurologist before the decision is made, and often your pharmacist will also place a call to your neurologist to get a green light to continue dispensing the medications in question once your pharmacist learns of your pregnancy. So at a minimum, 2-3 health care professionals decided that the safest choice for you and your babies was for you to remain on your medications.
No one can tell you for sure if your medications had any role in your children's autism. Certainly most of us mothers here aren't epileptic, yet many of us have multiple children who are affected by autism. Due to ethical and legal reason, drugs are not tested in pregnant women so the only data we usually have regarding their effect on pregnant women is from post marketing case reports or from animal studies. Based on this information there is a rating system used to rate the "danger" factor of drugs to pregnant and lactating women. The rating system is as follows:
CATEGORY INTERPRETATION:
A = Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities to the fetus in any trimester of pregnancy.
B = Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate and well-controlled studies in pregnant women. OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.
C = Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women. OR No animal studies have been conducted and there are no adequate and well-controlled studies in pregnant women.
D = Adequate well-controlled or observational studies in pregnant women have demonstrated a risk to the fetus.
However, the benefits of therapy may outweigh the potential risk. For example, the drug may be acceptable if needed in a life-threatening situation or serious disease for which safer drugs cannot be used or are ineffective.
X = Adequate well-controlled or observational studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities or risks.
The use of the product is contraindicated in women who are or may become pregnant.
There are NO category "A" drugs (that I am aware of) because there are NO controlled studies performed on pregnant women as I mentioned earlier.
There are many category "B" drugs and usually most health care providers don't get too worried when a pregnant woman is on a category "B" drug.
Categories C and D are the greyer areas. Category X drugs are never given without serious consideration and consequences (the only example I can think of is life saving chemotherapy for the mother that can not wait until after the birth of the child and may even lead to the decision to terminate the pregnancy).
Of the 3 drugs you mentioned, Keppra and Lamotrigine are category "C" drugs, Carbamazepine is a category "D" drug. Lamotrigine and Carbamazepine are thought to deplete the body of Folate which can lead to neural tube defects like spina bifida. Keppra has shown some association with developmental disabilities in
Animal studies (this does NOT mean it has the same effect in people!) Carbamazepine is the only category "D" drug you took and it is not associated with developmental disorders.
So what does all this boil down to for you? In my opinion you took vital medications that you needed during your pregnancies that without which you would have placed yourself at risk for serious medical consequences. While drugs taken by mom may pose some risk to the baby, uncontrolled seizures most certainly poses risk to both the baby and the mom! Oxygen levels can fall during a seizure and that can certainly harm a fetus, or an unexpected seizure while driving a car for example could threaten not just your own life, but the baby's life and possibly the lives of bystanders too.
As I said earlier, none of us mothers know for sure why our children have autism, and I'm sure most of us at some point have wondered if we did something to trigger the autism. Its a very human response to think that way. I hope I have given you some information that helps you to feel knowledgeable about the topic. And I hope I have also helped you to understand that you made the best choices to ensure the healthiest possible pregnancies.
Now, stop beating yourself up about things that are in the past and out of your control, and go give your kids a big hug and kiss. I believe my boys are the way they are because that is how God intended for them to be. And I believe the same about your children! Love them and appreciate them for the unique people they are! And never, ever wonder again if you are in any way responsible for their special needs. Your only responsibility is to love them and see to it that their special needs are met to the best of your abilities.
I wish you and your family the very best!
Leanne
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