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Thread: Pregnancy and Intrathecal Baclofen/Fentanyl & MSO4 can it be done? Help nurse!

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  1. #1

    Pregnancy and Intrathecal Baclofen/Fentanyl & MSO4 can it be done? Help nurse!

    I have an ITB baclofen/MSO4 and Fentanyl pump for the tx of Paroxysmal non kinesigenic Dystonia, CP, spasticity, fibromyalgia and chronic pain syndrome. We just added the MSO4 and are weaning off the fentanyl. It'll be removed w/my next pump refill in March. (possibly before) My husband & I are wanting to start our family. What are the risks of pregnancy with the pump and these meds? I am also on valium 10mg prn severe spasms, MSO4 60mg po prn severe breakthrough pain, Toradol 30mg IM 3x/wk prn severe breakthrough pain (used in conjunction w/mso4), Dilantin 100mg qhs. What can I expect with pregnancy and the pump? Will the catheter or pump move as the baby grows? Can the baby kick and hurt either the pump or catheter? Should I expect an increase in pain and spasms? Can I breastfeed? Will a c-section interfere w/the pump or catheter? (my pelvis is all catywampus and there's no way anything larger than an egg is coming outa there!) I don't think my spasms will allow my to push to boot. I need all the info, support, help and words of encouragement I can get. Unfortunately I often find the docs don't seem to give you all the info you need. Has anyone on this site gone through pregnancy w/any of these meds or the pump or know someone who has? What was their experience? Good bad and ugly. I need all the info I can get my fingers on. I find it upsetting that Medtronics (maker of the pump) has no information regarding pregnancy and the pump for patients on their website. I can't even find anything under their info for physicians site. Please, can someone direct me to where to find more info on this? Not just case studies (though those would be helpful and appreciated, too) but real life experiences. I'd love to talk w/someone who's been there, done that or is doing it now. Will the pump or drugs make it harder to get pregnant? Any ideas on ways to increase my chances of pregnancy? (all suggestions welcome, wives tales and all!) Thank you for your help

  2. #2
    I am going to ask either SCI-Nurses PLG or EMK to answer this one as this is more in their areas of expertise.

    (KLD)

  3. #3
    Snoopy -- First of all, I admire you for wanting to get started with a family. You are so right to be concerned with all of the medications you are on and what effects they may have on the growing fetus. As with any other drugs taken during pregnancy I am sure you will want to thoroughly discuss this first with your GYN/OB MD. If you have not made an appointment already I highly suggest you do this before getting pregnant. If you do not already have a physician you will want to find one who is an expert in handling high risk pregnancies so that you can be monitored frequently.

    Although the intrathecal baclofen and morphine pump drugs are
    delivered in such small but concentrated doses there shouldn't be as many
    risks as those medications taken orally. What my MedLine search tells me is
    that intrathecal baclofen has a "C" pregnancy risk category meaning that so far it looks to be safe but there are still not enough controlled studies to prove otherwise. When contacting Medtronic their stance is that "there are no adequate or well-controlled studies in pregnant women to rule out the absolute possibility of birth defects while taking the drug".

    The morphine falls into the "D" category meaning that definite evidence exists indicating a possible tetragenic effect on the fetus. Even at small doses there could be minimal risks and the mother would have to be carefully monitored with frequent ultrasounds, etc.

    Of the 100+ pump cases we have here, none have attempted pregnancy. If I find out anything different I will let you know. As far as the growing fetus changing the position of the pump, this would be dependent on where it is now and how close it is to the surface of the skin. The growing fetus would definitely put more pressure on the area and you would need to watch the abdominal site carefully for any protrusions or erosions of the skin. The baby may be able to kick at it but it should not harm the pump itself unless the kick is so forceful that the pump/catheter becomes dislodged. Again, careful troubleshooting along each stage of the pregnancy will need to be addressed. The growing fetus will place additional pressure on your abdominal organs and you will need to be monitored for additional spasms, bladder/bowel problems and/or autonomic dysreflexia if you have a higher SCI.

    You are on other drugs as well that could pose a risk to your growing fetus. Again, I would highly suggest you set up an appointment to go over each and every medication thoroughly with the GYN/OB doctor before you get pregnant.

    What your doctor will have to decide along with you and your husband is the continued use of drugs where the potential benefit outweighs the potential risks to your fetus. What he/she may consider is weaning you down or off some of your drugs before you get pregnant and/or during the pregnancy to avoid the risks. This again will need to be carefully decided between all parties including your regular SCI MD or primary MD. Good luck and keep us posted. PLG

  4. #4
    Snoopy --

    Here are some references about intrathecal baclofen and pregnancy to check
    out:

    http://phth.allenpress.com/phthonlin...sn=1060-0280&v
    olume=034&issue=07&page=0956

    Here are a couple references on pregnancy and intrathecal morphine:

    http://www.ncbi.nlm.nih.gov/entrez/q...PubMed&list_ui
    ds=11153344&dopt=Abstract

    http://www.ncbi.nlm.nih.gov/entrez/q...PubMed&list_ui
    ds=8857260&dopt=Abstract


    PLG

  5. #5

    Thanks

    PMG, thank you for your help. I've already checked out the links you gave me. They were given to me by the person who recommended I post my pregnacy question here. Do they have a complete history of the case studies they talk about? I just got tidbits of info. I'm wondering if there's a full case study somewhere. Wow, outa 100+ pump patients, you'd think someone would get pregnant @ some point! I haven't been able to find anyone anywhere who knows someone or has gotten pregnant themselves with the pump. This is very frustrating! I would feel much better actually talking w/someone who's been through or going through it. Studies and statistics just can't make up for life experiences. I think I'll suggest to Medtronics adding a chat group and info for women wanting to get pregnant with the pump. With your experience and professional insight, do you think maybe you and your collegues could make the same suggestion? I don't know if they'll be interested in the idea from just one "lay" person. I do have an appointment set up w/my OB/GYN to talk more in depth about it. We had talked some @ my last ov prior to my pump placement. Thesad fact is, she (along w/most of the docs here in town) knows little or nothing about the pump. I am the first patient she, my PCP, one neurologist, and my urologist have seen with the pump. That's amazing to me as we don't live in BFE. Austin is quite a large city unfortunately it's comprised of a medical community stuck in the dark ages and they seem to like it that way. My OB has said all along she would set me up w/a high risk pregnancy specialist. Hopefully he will know about the pump. I will keep ya posted. I plan to talk to my pain doc and new neuro about it as well. Keep your fingers crossed. Once we get the go ahead, any tips on increasing my chances of becoming pregnant?

    Thanks and God bless!

  6. #6

    Articles

    Snoopy, the posted articles are abstracts (summaries) only. The actual full article source is listed at the top, and should be able to be obtained at a medical library by your physician (or yourself if you have access to one at the local university).

    I suspect that the low rate of pregnancy in people with pumps is due to 1) most of the people who have SCI are male (4 males for every female) and also that pumps tend to be put in later in life for many people with SCI who have worked for a long time to find other ways to manage their spasticity, and may be beyond child-bearing or not planning to have children. This may also be true for those users with MS, which is a larger group of women than men.

    (KLD)

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