Q: May I take Topamax while I'm pregnant?
CATEGORY C: Adverse effects in animal studies but there are no human studies.
A: Not unless it's absolutely necessary. Here's why: When used during pregnancy, Topamax (generic name: topiramate), an oral medication used alone or in combination with other medications to treat seizures (it's also used for bipolar disorders and migraines), can lead to an increased risk of miscarriage as well as facial anomalies and abnormalities in the baby's brain and genitalia. "It's not recommended to take Topamax during pregnancy unless your neurologist says you must," says Dr. Roshan.
If your neurologist wants you to stay on the drug while you're pregnant, there's a registry you can call (888-233-2334) that will follow your health (and your baby's) throughout your pregnancy. Deciding whether (or not) to take this drug comes down to weighing the benefit of the drug (controlling seizures) against the risks to your baby. "If at all possible, Topamax should be avoided during the first 14 weeks of pregnancy," adds Michele Hakakha, M.D., co-author of Expecting 411. "And, if a woman must be on Topamax during pregnancy because nothing else is controlling her seizures, it's strongly recommended that she take additional folic acid (four milligrams a day instead of the standard 400 micrograms) daily." A consultation with the obstetrician, neurologist and a high-risk OB specialist is key to help you come up with the best plan for you.