You should continue to take LAMOTRIGINE. An overall increase in major congenital malformations has not been observed in available studies; however, an increased risk for cleft lip or cleft palate has not been ruled out. An increased risk of malformations following maternal lamotrigine use may be associated with larger doses (over 400 mg a day).
You may continue to take Propylthiouracil. Teratogenic effects have not been observed; however, nonteratogenic adverse effects, including fetal and neonatal hypothyroidism, goiter, and hyperthyroidism, have been reported following maternal propylthiouracil use. Uncontrolled maternal hyperthyroidism may result in adverse neonatal outcomes (eg, prematurity, low birth weight
) and adverse maternal outcomes (eg, pre-eclampsia, congestive heart failure, stillbirth
, and abortion
). To prevent adverse fetal and maternal events, normal maternal thyroid function should be maintained prior to conception
and throughout pregnancy
. Antithyroid treatment is recommended for the control of hyperthyroidism during pregnancy. Propylthiouracil is considered first-line therapy, especially during the first trimester
. Due to an increased risk of liver toxicity, use of methimazole may be preferred during the second and third trimesters
You should not take LISINOPRIL. It is associated with oligohydramnios. Oligohydramnios, due to decreased fetal renal function, may lead to fetal lung hypoplasia and skeletal malformations. Its use in pregnancy is also associated with anuria, hypotension, renal failure, skull hypoplasia, and death in the fetus
/neonate. We suggest therapy with either methyldopa or labetalol. A long-acting calcium channel blocker (eg, nifedipine) can be added if needed.
You may take bupropion. An increased risk of congenital malformations has not been observed following maternal use of bupropion during pregnancy; however, data specific to cardiovascular malformations is inconsistent. The long-term effects on development and behavior have not been studied.