Pregnancy and Pain

[Phillis]

My husband and I are talking about trying to get pregnant in 6 months or so. I have severe neuropathic pain which presently isn't controlled by any of the meds I take. I currently take Neurontin, Trileptal, Dextromethorphan and Ultracet. In talking with my OB/GYN, she advises definitely getting off everything other than the Neurontin which is moderately safe to take during pregnancy. Ideally, she would like me off the Neurontin too. I'm just wondering if anyone here has gone through a pregnancy with the severe pain. I usually have worse pain while I have my period and my fear is that the pain will worsen with the pregnancy. Regardless, I'm just wondering how difficult it was for others to be pregnant and have the pain. I thought maybe someone here could give me some real life feedback. Thanks.

Keep hope alive.

[David Berg]

Phillis,

You have a huge decision to make. From what I understand, pregnancy itself probably won't affect central pain, but there are many other factors to consider.

First, I'll address the matter of using Neurontin during pregnancy. Your doctor probably has good information available, but you should take a look at Pfizer's website. Here's the section on pregnancy:
Pregnancy
Pregnancy Category C: Gabapentin has been shown to be fetotoxic in rodents, causing delayed
ossification of several bones in the skull, vertebrae, forelimbs, and hindlimbs. These effects
occurred when pregnant mice received oral doses of 1000 or 3000 mg/kg/day during the period
of organogenesis, or approximately 1 to 4 times the maximum dose of 3600 mg/day given to
epileptic patients on a mg/m 2 basis. The no-effect level was 500 mg/kg/day or approximately ½
of the human dose on a mg/m 2 basis.
When rats were dosed prior to and during mating, and throughout gestation, pups from all dose
groups (500, 1000 and 2000 mg/kg/day) were affected. These doses are equivalent to less than
approximately 1 to 5 times the maximum human dose on a mg/m 2 basis. There was an increased
incidence of hydroureter and/or hydronephrosis in rats in a study of fertility and general
reproductive performance at 2000 mg/kg/day with no effect at 1000 mg/kg/day, in a teratology
study at 1500 mg/kg/day with no effect at 300 mg/kg/day, and in a perinatal and postnatal study
at all doses studied (500, 1000 and 2000 mg/kg/day). The doses at which the effects occurred are
approximately 1 to 5 times the maximum human dose of 3600 mg/day on a mg/m 2 basis; the no-effect
doses were approximately 3 times (Fertility and General Reproductive Performance study)
and approximately equal to (Teratogenicity study) the maximum human dose on a mg/m 2 basis.
Other than hydroureter and hydronephrosis, the etiologies of which are unclear, the incidence of
malformations was not increased compared to controls in offspring of mice, rats, or rabbits given
doses up to 50 times (mice), 30 times (rats), and 25 times (rabbits) the human daily dose on a
mg/kg basis, or 4 times (mice), 5 times (rats), or 8 times (rabbits) the human daily dose on a
mg/m 2 basis.
In a teratology study in rabbits, an increased incidence of postimplantation fetal loss occurred in
dams exposed to 60, 300, and 1500 mg/kg/day, or less than approximately ¼ to 8 times the
maximum human dose on a mg/m 2 basis. There are no adequate and well- controlled studies in
pregnant women. This drug should be used during pregnancy only if the potential benefit
justifies the potential risk to the fetus.

The entire drug info on Neurontin is avaiable at http://www.pfizer.com/download/uspi_neurontin.pdf

Aside from issues like Neurontin, (which may not be a worry) your really need to consider what happens after the baby is born. I presume this would be your first child, and as the father of four (plus a foster child), I can state that parenthood, especially of an infant, is probably the hardest thing you'll ever undertake. It will try you to the end of your physical and emotional reserve. Yes, it's worth it, but give a long, hard look at your support network before you get yourself into this situation. If you are ready to manage it, then I'll offer my congratulations in advance. If not, then consider other alternatives, such as adopting a slightly older child.

At any rate, raising a young child while you have central pain will be a tremendous challenge. I won't try to discourage you, but I truly hope that you'll consider the matter, especially what happens after the birth, very carefully.

David Berg