Extremely concerned about a medication I took during pregnancy

posted 3 years ago in Pregnancy
Post # 31
Member
3003 posts
Sugar bee
  • Wedding: September 2008

This sort of thing happens literally all the time.

I had a coworker do meth before she realized she was pregnant and she had two beautiful smart healthy twins. Another coworker got into a car accident and was recovering by taking Tylenol with codeine when she found out she was pregnant with her second child. Her son was fine. 

Me? I took a pregnancy test that came out negative so enjoyed some mulled wine during the holidays. Three weeks later I took another pregnancy test and apparently was 5 weeks pregnant! My baby is a happy healthy girl.

It’s my understanding that these sorts of things can’t even affect the baby until the placenta is fully formed anyways, so I would just book your prenatal care appointment and let your OB screen you for any abnormalities that probably aren’t even going to be present. 

Post # 32
Member
602 posts
Busy bee
  • Wedding: September 2014

You need to calm down if you’re already contemplating termination over this.  My guess is your anxiety is way worse for the baby than this one-time drug at such an early stage.  Many women drink and take medications for weeks before knowing they are pregnant and usually the baby is fine. 

I think you will be just fine.  I have anxiety too, and I suspect that getting a doctor’s opinion is not going to sufficiently help your anxiety.  The doctor will not tell you absolutes because there are no absolutes.  The doctor can not 100% tell you that the baby will be fine.  They’ll tell you it’s probably fine and not to worry.  But you’ll still worry, and you’ll wonder if the doctor is wrong, or what “probably” means, and a million other things.  And that’s just the first step of raising a child.

Have you tried therapy?  I’ve found it really helpful in handling my own anxiety.

 

Post # 34
Member
602 posts
Busy bee
  • Wedding: September 2014

 MrsSnowMountain :  I wasn’t referring to whether termination is right or wrong.  That’s entirely your choice, and I would certainly understand if there was a high risk.  My concern was that your anxiety might influence a decision that it normally wouldn’t, if that makes sense, and causing you to get way ahead of yourself.  I have anxiety, I know what it’s like once you start panicking, and it can be difficult to take a step back. 

Post # 36
Member
2427 posts
Buzzing bee
  • Wedding: April 2014

MrsSnowMountain :  I’m not entirely sure what you are reading that is still causing skepticism in regards to the placental development and sharing of nutrients with the fetus.

My first two US at 6.5 & 7.5 weeks showed a fetal pole and yolk sac. My first OB appointment at 9 weeks was the first US that showed the placenta developing but not entirely formed. My RE and OB instructed me to stop all IVF meds at 11 weeks because at that point, the placenta should be fully forming and start taking over the hormonal production.

Here are a few articles that describe what is happening in terms of fetal development: 

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-weeks-4-5-6-7-8.aspx?tabname=pregnancy

http://www.whattoexpect.com/pregnancy/placenta

http://www.merckmanuals.com/home/women-s-health-issues/normal-pregnancy/stages-of-development-of-the-fetus

To be completely honest, I would be more concerned if you were taking this medication (regularly or not) prior to or during the time of conception than I would be the one time use after conception occurred. Since the embryo contains cells that during implantation, break away and attach to the uterine wall/become the eventual placenta, and the baby itself is formed at this time, it would be more likely that birth defects or issues would occur at this time.

In most of these people’s defense, no one was claiming there couldn’t have been some ill effect to the embryo at this stage – but if it was truly a one time medication AFTER the stage of conception, it likely won’t harm the baby one bit.

As far as termination goes, unless you miscarry prior to your first appointment, you won’t know for sure what types of genetic issues or malformations can occur until at the earliest, 10 weeks, when you have a free-cell DNA test done or at 12 weeks, when an ultrasound can take measurements and look for abnormalities. I think you are jumping the gun a bit at this point.

 

Post # 37
Member
8882 posts
Buzzing Beekeeper

I really do not think 1 pill will do much harm.  It’s very early in the pregnancy and it was only one pill. Some anxiety medications are fine during pregnancy, I’m currently on Zoloft and my doctor is keeping me on it. 

Post # 38
Member
505 posts
Busy bee
  • Wedding: August 2012

BeverlyGeese :  I think all are in agreement on when the placenta takes over. But there are other ways chemicals ingested by the mother can impact the embryo and/or fetus. There are a number of medications that women are advised to stop taking due to their potential influence on the baby that does not have to do with passing through the placenta at the time the chemical is ingested (see previous page of this thread regarding one such study regarding alcohol which can impact the embryo from weeks 3-6 long before the placenta takes over). 

ETA: Quick quotation from an NIH study on drugs during pregnancy: “Certain drugs taken early in pregnancy (15-21 days after fertilization) during the period of blastogenesis may act in an all or nothing fashion; killing the foetus or not affecting it at all. During this early stage the fetus is highly resistant to birth defects. The fetus is highly vulnerable to birth defects between 3<sup>rd</sup> week and 8th week after fertilization; which is the period of organogenesis.” Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810038/ 

So, again, we really don’t know the particulars of this situation- the drug was taken at the cusp of this time frame (3 weeks after fertilization, or 5 weeks pregnant, as OP said, if her timeline is exactly accurate) and we don’t know the mechanics of this certain chemical and when/how/if it was passed to the embryo. 

I do agree with you (though I clearly do not have a medical degree!) that one single use of a medication contraindicated with pregnancy is unlikely to do harm, but I do think it is important to note that there are other ways and times a chemical can reach an embryo besides via the placenta. And obviously thoughts and prayers with the OP during this really tough situation.

Post # 39
Member
2427 posts
Buzzing bee
  • Wedding: April 2014

indiblue :  I was simply replying to OP when she asked me, “I’m obviously on the side of hoping this is true even though everything I’ve read leads me to heavy skepticism… Do you have a reliable source? That would certainly put my mind at ease to read.” It did not seem like she was in agreement or understanding of when the placenta takes over, since she responded directly to my previous post regarding when it does, so I simply responded to that. Not sure why you felt the need to state that we are all in agreement or call me out?

I read the first study you linked, and the biggest issue I saw was that the scientests who studied the effects of alcohol on the mice did not disclose how much/how often they were injecting the mice. There have been many other studies that state that FAS is generally found in mothers who are heavy and/or habitual users of drugs or alcohol throughout the ENTIRE preganancy. I don’t disagree that there are certain drugs that women are told to stop taking prior to conception and during pregnancy, because of the risk of defects. This is why they are advised to stop taking the medications 3-6 months prior to TTC since it effects not only the egg quality but the DNA structure of a fertilized egg. The medication OP took is a certified Category D for pregnancy, meaning there is positive evidence of fetal risk if taken at ANY time during pregnancy. However, as I stated before, a one-time medication most likely won’t harm the fetus at such an early stage, because while it can potentially cross the few placental cells that are formed, the placenta is literally not attached to an umbilical cord and the only source of nutrients at this time comes from the yolk sac.

As far as the NIH study goes, a few points that I thought were important to share: “The effect of a medication also depends on the dose that reaches the fetus. This dose is affected by the maternal dose, distribution of the drug in maternal blood stream, placental function, maternal and fetal genetic and physiologic status as well as exposure to other drugs, chemicals or environmental hazards.” In terms of placental function, it goes on to state, “In order for a drug to cause a teratogenic or pharmacological effect on the fetus, it must cross from maternal circulation to fetal circulation through the placenta by diffusion[8]. The rate of transfer depends on the chemical properties of the drug such as protein binding, pH difference, lipid solubility and molecular weight of the drug[11]. Only free unbound drug crosses the placenta. During pregnancy maternal plasma albumin decreases while fetal albumin increases. As a result the concentration of free drug increases which crosses the placenta to reach the fetus.”

If the placenta is literally not connected to the fetus at the time of drug ingestion, then it theoretically cannot reach the fetus.

Post # 40
Member
505 posts
Busy bee
  • Wedding: August 2012

BeverlyGeese :  I am in no way trying to call anyone out. OP replied to me with the comment: “I’m definitely super skeptical of anyone claiming there isn’t some ill effect on the embryo until 8ish weeks” so I was attempting to help articulate her concerns while finding areas of mutual agreement.  And i think there is a great deal of such- as we both have said, one dose is unlikely to cause harm in this case.

My only point from linking to the quotation from that study is that teratogenic agents are more likely to cause major congenital malformation during organogenesis (between days 15 to 60 after conception), which begins even before placenta takes over. I think it’s important to emphasize the timeline to avoid the assumption that teratogenic agents only pass through the placenta and therefore can only impact the embryo after the placenta takes over. Perhaps I misread but that’s what seemed to be intimated here and there throughout the thread. 

I’ve shared my perspective and I don’t have a medical degree so I’m going to duck out of the conversation that’s now out of my depth 🙂 Y’all can continue to discuss if it is helpful for the OP. Again, no criticism meant towards anyone- just contributing to the dialogue. 

Post # 41
Member
893 posts
Busy bee

MrsSnowMountain :  In Canada your best bet is to call Motherrisk. They ar associated with the Sick Kids Hospital in TO and have all the latest reasearcb on any drug in relation to pregnancy. My doctor and midwives both advised me to contact them with any medication questions relating to pregnancy. 

http://www.motherisk.org 

Post # 43
Member
755 posts
Busy bee
  • Wedding: February 2016

Doctor here. I second giving Motherisk a ring / email – they are a wonderful source of information. 

Realistically your chances of causing harm with a one-off dose of bromazepam are minuscule. I see women frequently who’ve taken a variety of drugs (prescription and illegal) in the early stages of pregnancy and it’s quite rare to see significant effects on the foetus outside the setting of ongoing regular use. 

If you are really concerned a chat with a Maternal-Foetal medicine physician would be highly adviseable, your family doc can refer you. 

And finally some info for you re risk of abnormalities with Bromazepam – note this relates more to regular use rather than a single episode, but hopefully it provides some reassurance.

 

Post # 44
Member
2122 posts
Buzzing bee
  • Wedding: June 2014 - DD born 2015 DS born 2017

MrsSnowMountain :  Medication you take can’t alter your baby’s chromosones, that’s decided at fertilization. If there is indeed a risk of cleft lip that a pp mentioned (I am totaly clueless, just teading comments) there is some evidence good old folic acid can help prevent it so get on your prenatal and try not to stress too much. Everything’ll be fine 🙂

Post # 45
Member
2675 posts
Sugar bee
  • Wedding: May 2017

ajillity81 :  I’m also in Canada, I do not have a family doctor and haven’t for years, I’ve been on a waiting list for one for 5 years, depending on where you are while we have government provided coverage for things here we are greatly lacking the doctors to provide it. A few months ago I went and waited in emergency for 4 hours (because you are dead last if it’s not an actual emergency) just to get my birth control prescription renewed because the walk in clinic was so full they were turning people away and saying “try another day”

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