CASE LEARNING OBJECTIVES
Develop an appropriate treatment plan during pregnancy
Properly educate a patient taking drugs during pregnancy
Identify the risks of epilepsy during pregnancy
Identify the risks of anticonvulsants during pregnancy and lactation
History of Present Illness
Loretta Baldwin is a 26-year-old woman who presents to her primary care physician after completing a pharmacy pregnancy test that was positive 2 days ago. Her period is 3 weeks late. Her menstrual cycle is usually 28–32 days. She stopped her medications yesterday because she has been told that they may cause fetal malformations. She has never been pregnant before.
Epilepsy (generalized tonic–clonic seizures) for 13 years following viral encephalitis. No seizures since one episode last year. Last visit to her neurologist 6 months ago.
Overweight since childhood
Mother is alive at age 51 with DM, obesity, and HTN. Father is alive at age 53 with hypothyroidism. She has one brother who is healthy and two sisters who had normal pregnancies. There have been no multiple pregnancies in the family.
Born in the United States. Married and lives with her husband. Works full time as a clerk. Dislikes fruit and vegetables, eats two meals a day, often in fast-food restaurants. (−) Exercise. No pets.
Social drinker; (−) tobacco or illicit drug use
Allergies/Intolerances/Adverse Drug Events
Phenytoin (unknown reaction at age 13)
Lamotrigine 200 mg PO twice daily, stopped yesterday
Carbamazepine CR 400 mg PO twice daily, stopped yesterday
MOM 30 mL PO once daily as needed for constipation
Feverfew herbal tea two to five times a week
Ibuprofen 400 mg PO as needed for HA, twice weekly in the last month
No seizure; occasional HA relieved with ibuprofen; increased urinary frequency and constipation in the past 2 weeks; occasionally SOB; tiredness and mild nausea.
Overweight young Caucasian woman in no acute distress
BP 112/76 mm Hg, P 89, RR 12, T 36.2°C
Weight 207.2 lb (94.2 kg)