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Can Dilantin Affect Offspring?
Q: My husband and I are in the process of adopting two boys, ages six and eight. The boys' birth mom has had a seizure disorder from the time she was an infant -- so severe in fact that she recently underwent a partial lobotomy. Throughout her pregnancies with both boys, the birth mom took Dilantin to control her seizures. I've heard a lot of conflicting information about the effects of this drug on the fetus. What effects might Dilantin have on the boys?
A: There are a number of drugs that are known to be "teratogenic" -- defined as causing changes in appearance or functioning when the fetus is exposed to the drug in the womb. In general, exposure during the first trimester is usually most harmful. Unfortunately, seizure medicines are one of those classes of drugs that are potentially very problematic when taken by a pregnant woman. There is no known dose amount that has been determined to be associated with specific patterns of malformation. Whenever possible, pregnant women are counseled about the medicine's potential impact on their newborn and attempts are made to limit the dose of medicine needed to the lowest amount possible. Often times, stopping the seizure medicine(s) during pregnancy may precipitate seizures in mom that can be hazardous to both the mom and fetus.
Dilantin used throughout pregnancy is associated with adverse congenital effects, including poor growth beginning prenatally, mild to moderate mental deficiency, depressed nasal bridge, short forward-positioned nose, bowed upper lip, cleft lip with or without cleft palate, heart defects, and poor nail development. Multiple behavioral effects including locomotor and learning and memory deficits have reportedly been produced by Dilantin in some studies.
You have not provided any detailed information about the boys' physical characteristics or their development to date. Genetic factors may also play a role. Under the present circumstances, I would suggest a consultation with a geneticist who is in the best position to provide you with the education and support you need for the boys and their birthmom.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.