Minimize Teratogenic Risk

A general approach to reduce the risk of human teratogenesis includes planning for pregnancy. Prior 

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Withdrawal of medication from an epileptic pregnant woman is not without its hazards, to the patient and possibly to the fetus. It is not clear whether maternal seizures can directly affect the fetus. If it is feasible, the physician should prescribe only one drug at the lowest effective dosage to minimize teratogenic risks. 

Discuss general methods by which teratogenic risk and drug exposure during pregnancy and lactation can be minimized. 

Consideration of the implications of teratogenicity in animals leads to the (somewhat vexed) question of maternal toxicity. Since the publication of papers by Khera for example (9), there has been a view expressed in some snbmission documents that if effects on reprodne-tion occur in the presence of maternal toxicity, then these effects can almost be discounted or certainly their significance is minimized. While this might apply in some cases, it certainly does not apply universally and can lead to misleading risk-benefit assessments. 

There are few data about the safety of topical retinoids during pregnancy. The risk of teratogenicity of topical tretinoin, if any, appears to be minimal (SEDA-18, 164) (109). However, there is a case report (110). 

A young female patient who suffers from bipolar affective disorder (BAD) has been managed with lithium. If she becomes pregnant, which one of the following drugs is likely to be effective in bipolar affective disorder with minimal risk of teratogenicity ... 

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