CARBAMAZEPINE AND VIGABATRIN DURING PREGNANCY - SIDE-EFFECTS IN THE NEWBORN

Background, - Carbamazepine (Tegretol(R)) is frequently prescribed to pregnant epileptic women. Various congenital malformations constitute the most described side-effects in their newborns. Case reports, - Cas e 1, Esteban was born by caesarian section at 39 weeks of gestation, w eighing 3,860 g. His Apgar score was 8, 9, 10 at 1, 3 and 5 minutes. H is mother was given phenobarbital until 1.5 months of pregnancy then c arbamazepine 400 mg LP x 2/day, raised to 600 mg L.P x 2/day at the 25 th week of gestation because of epileptic crisis. The newborn was tran sferred at day 4 for drowsiness, mild jaundice, persistent vomiting an d bouts of hypotonia/hypertonia, tremors and hyperexcitability. His pl asma Tegretol(R) level was 5.9 mu g/mL and severe hypocalcemia (1.35 m mol/L) was noted. Hypocalcemia disappeared within 48 hours and gastric and neurologic troubles by day 6. The patient left the hospital at da y 14. Case 2, Matheo, Esteban's brother, was born by caesarian section after 39 weeks of gestation, weighing 3,210 g. His Apgar score was 9, 10, 10, at first, third and fifth minutes. The mother's anti-epilepti c treatment associated carbamazepine LP 400 mg x 3/day and vigobatrin four tablets of 500 mg/d until the 6(th) month of pregnancy and five t ablets by day thereafter. The newborn presented vomiting from the firs t feeding; tremors were noted on day 2, His plasma Tegretol(R) level w as 5.7 mu g/mL (N = 4-8 mu g/mL) and the baby was transferred. Upon ar rival, persistent vomiting and succession of hypotonia/hypertonia with intermittent opisthotonos were noted. Blood and urine tests showed: l ow calcemia (2.19 mmol/L), negative Brand reaction and DNPH test, norm al urinary and blood amino acid chromatography. The course was spontan eously favourable and the child went home at day 11. Conclusion. - New borns of epileptic mothers treated with carbamazepine and/or vigabatri n during pregnancy should be placed under clinical observation during their first postnatal week. Calcemia monitoring is suggested for infan ts whose mothers were not supplemented with vitamin D during pregnancy . With a follow up of respectively 26 and 7 months, both brothers have normal milestones, confirming the transitory and benign character of reported side-effects.