First of all, Topamax is in Category D for use of drugs during pregnancy. What this means is that "there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks."
Please note that these studies were done with Topamax and other anti-seizure drugs included. As of spring 2011, Topamax (topiramate) is now Category D for use of drugs during pregnancy.
But wait! Before you get upset..the incidence of fetal defects in the normal human population is about 1-1.2%. On Topamax it is about 2-2.3%. So..does it happen? Yes. It it very high? No. It is best to avoid this medication during pregnancy if possible. The most common birth defects include a cleft palate and some children may be born with a hydrocele on the lip. This usually goes away, but a cleft palate must be surgically repaired.
What To Do If You Get Pregnant On Topamax
First of all..call your doctor's office. Both your OB/GYN and your neurologist if you think you are pregnant. Assuming you are, and are only on a low dose of 100mg or so you can probably stop the medication right away. Your doctor may recommend tapering off it, but even then you will be off quickly.
NOTE: Do not suddenly stop any anti-seizure drug if you are on higher doses. The risk of having a seizure from sudden withdrawl may do more damage to you and the baby than staying on the medication for a bit.
Migraine, Topamax And Pregnancy
Ok..now you have stopped this great migraine medication and your headaches are coming back. While 70% of migraineurs will improve or have no migraines during prenancy, 30% don't. If you are one of the unlucky 30%, cheer up, there are still options for you.
Read about how to manage headaches in pregnancy. Many times headaches in pregnancy will resolve after the first trimester, and can be treated with low doses of either Tylenol in pregnancy or Tylenol with codeine.
As always, please call your physician when making decisions about topamax and pregnancy.