[Carbamazepine and vigabatrin in epileptic pregnant woman and side effects in the newborn infant].

BACKGROUND

Carbamazepine (Tegretol) is frequently prescribed to pregnant epileptic women. Various congenital malformations constitute the most described side-effects in their newborns.

CASE REPORTS

Case 1. Esteban was born by caesarean section at 39 weeks of gestation, weighing 3,860 g. His Apgar score was 8, 9, 10 at 1, 3 and 5 minutes. His mother was given phenobarbital until 1.5 months of pregnancy then carbamazepine 400 mg LP x 2/day, raised to 600 mg LP x 2/day at the 25th week of gestation because of epileptic crisis. The newborn was transferred at day 4 for drowsiness, mild jaundice, persistent vomiting and bouts of hypotonia/hypertonia, tremors and hyperexcitability. His plasma Tegretol level was 5.9 micrograms/mL and severe hypocalcemia (1.35 mmol/L) was noted. Hypocalcemia disappeared within 48 hours and gastric and neurologic troubles by day 6. The patient left the hospital at day 14. Case 2. Matheo, Esteban's brother, was born by caesarean 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-epieptic treatment associated carbamazepine LP 400 mg x 3/day and vigabatrin four tablets of 500 mg/d until the 6th month of pregnancy and five tablets by day thereafter. The newborn presented vomiting from the first feeding; tremors were noted on day 2. His plasma Tegretol level was 5.7 micrograms/mL (N = 4-8 micrograms/mL) and the baby was transferred. Upon arrival, persistent vomiting and succession of hypotonia/hypertonia with intermittent opisthotonos were noted. Blood and urine tests showed: low calcemia (2.19 mmol/L), negative Brand reaction and DNPH test, normal urinary and blood amino acid chromatography. The course was spontaneously favourable and the child went home at day 11.

CONCLUSION

Newborns of epileptic mothers treated with carbamazepine and/or vigabatrin during pregnancy should be placed under clinical observation during their first postnatal week. Calcemia monitoring is suggested for infants 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.