Bipolar medications and birth defects

[Update: I ended up taking a combination of lithium and Lamictal while pregnant.  My son was born at 36 1/2 weeks because of a heart arrhythmia that was ironically not related to the lithium or Ebstein's Anomaly.  He spent 16 days in the hospital, first in the cardiovascular ICU and then the regular NICU.  He came home before his original due date.  Initially, some of his gross motor skills were delayed, but that was attributed to being tied to his bed for 2 weeks.  At nearly 2 he is right on track with most developmental things, ahead on a few. Who knows how and why things turned out the way that they did, but I feel that we played the odds and won.  And even if we could, we're not going to have another.  We're not going to get greedy. --CTS, Jan/2013]

This is just a place for me to put together some of the information I've found so far.

National Alliance on Mental Illness (NAMI):

• Managing Pregnancy and Bipolar Disorder.
• Taking Mood Stabilizers during the Childbearing Years
• Pregnancy Pointers for Women with Psychiatric History: "If psychiatric medication is prescribed, it is better to use one that has been marketed for 20 years or more."

Incidence of birth defects while using drugs vs. no drug*

* Remembering that no drugs ≠ good idea

Lamictal: risk of cleft palate

• without medication: 0.50-2.16 per 1000
• with Lamictal: 8.9 per 1000
• FDA: "The clinical significance of the currently unconfirmed association between lamotrigine and oral clefts remains uncertain pending further data collection in pregnancy registries or through other research."
• Lamictal info from NAMI

Lithium: risk of Ebstein's Anomaly (serious heart valve problem--multimedia library) info from NAMI:

• without lithium: 0.05 per 1,000 (1 in 20,000)
• with lithium: 0.5-1.0 per 1,000 (10-20 in 20,000)
• Obviously, that a huge increase over the general population, but much less than the risk of cleft palate with Lamictal (8.9 per 1,000)

For comparison: risk of Down Syndrome

• at age 35: 1 in 350 (2.9 per 1,000)

Others:

• FDA: "The NAAED Pregnancy Registry has previously established an association between major malformations and the antiepileptic drugs phenobarbital and valproate."

Throw these numbers into the Num-BO-tronic 2008 and it spits out:

• Cleft palate (Lamictal): 8.9 per 1000
• Ebstein's Anomaly (Lithium): 0.5-1.0 per 1,000
• Down Sydrome (age 35-40): 2.9-10 per 1,000

• Lamictal's risk of cleft palate is higher than lithium's risk of Ebstein's Anomaly and Down Syndrome (until age 40)
• Lithium is my first choice. You know, after the world where I'm surrounded by flowers and puppies and I don't have a mood disorder.

This was so hard to put together. I am okay with numbers and all, but then I start picturing a baby. Our baby. And I can't focus on the surgeries and all of that. We can research and know that we live near some amazing hospitals for children. And just pray that our baby turns out okay. So we can harm him or her in all the normal parental screw-up kinds of ways.