Spina Bifida Association: October's Ask the Doctor
October's Ask the Doctor
Question:
I am a 21-year old-woman with Spina Bifida and just got married. We are looking forward to having a child soon. We were wondering about the use of Ditropan during pregnancy and nursing.
We are getting many different responses. Some doctors say there is no study as yet, and they cannot say if there are any adverse effects on fetus or nursing. Yet, obstetricians and urologists say that it does affect nursing as it dries up the milk. Some doctors recommend avoid using it during pregnancy because there is no known effect.
I really do well with Ditropan (in keeping dry between cathing) and yet want to be cautious. What do you think? Also, are there are other natural solutions to relaxing the bladder (i.e. cranberry tablets)?
Answer:
Congratulations on your recent marriage. There are many considerations before becoming pregnant when you have Spina Bifida. Most important is taking supplemental folic acid to help reduce the risk of neural tube defects for your baby. Because you have Spina Bifida, it is recommended you take 4mg of folate daily beginning at least one month before you become pregnant. This is 10 times the dose that is in regular prenatal vitamins, but you should not take 10 prenatal vitamins to get that dose. Be sure to talk with your urologist, gynecologist, and neurosurgeon (if you have a shunt) about preparing for your pregnancy. There are other issues related to pregnancy for women with Spina Bifida which were discussed in the August 2007 and October 2007 “Ask the Doctor” located in the archives.
As for Ditropan, your doctors are correct that there is nothing published about the effects of this medicine on human pregnancies. Those medicines which have clearly demonstrated problems with pregnancy usually get reported in the medical literature, so we can say that there are no problems commonly identified with ditropan. However, no report of harm does not mean that we can guarantee no harm. We do know women have taken Ditropan during their pregnancy and have delivered healthy babies. The FDA has labeled ditropan as Category B which is the same as many medications commonly prescribed in pregnancy. This means that there are no studies of safety in humans but animals studies (usually rodents) have shown no harm to the fetus.
If you decide to stop using Ditropan during your pregnancy, this will likely cause your bladder to hold less urine, which will get worse as the baby grows in your uterus and presses down on your bladder. You will need to catheterize more frequently to prevent accidents and to decrease the possibility of bladder infections. Bladder infections are not good for you or for the baby so you may want to talk to your gynecologist or urologist about antibiotic suppression. There are antibiotics that are safe to prescribe in pregnancy. Cranberry tablets can make the urine more acidic and less prone to infections but are not a substitute for ditropan to relax the bladder. You will still need to catheterize more frequently if you stop the ditropan.
As for breastfeeding, we do not know if ditropan passes into the breastmilk. Because the medication is an anticholinergic, it can cause drying up of any secretion, including breastmilk. Staying hydrated for the nursing mother may help.
Best wishes on your pregnancy!
Resource: Weiner CP, Buhimschi C. Drugs for Pregnant and Lactating Women - 2nd Edition. Saunders Elsevier. Philadelphia. 2009.
SBA's National Resource Center provides high quality, confidential information and referral services. For more information or to ask a question, please email sbaa@sbaa.org or call 800-621-3141.
I am a 21-year old-woman with Spina Bifida and just got married. We are looking forward to having a child soon. We were wondering about the use of Ditropan during pregnancy and nursing.
We are getting many different responses. Some doctors say there is no study as yet, and they cannot say if there are any adverse effects on fetus or nursing. Yet, obstetricians and urologists say that it does affect nursing as it dries up the milk. Some doctors recommend avoid using it during pregnancy because there is no known effect.
I really do well with Ditropan (in keeping dry between cathing) and yet want to be cautious. What do you think? Also, are there are other natural solutions to relaxing the bladder (i.e. cranberry tablets)?
Answer:
Congratulations on your recent marriage. There are many considerations before becoming pregnant when you have Spina Bifida. Most important is taking supplemental folic acid to help reduce the risk of neural tube defects for your baby. Because you have Spina Bifida, it is recommended you take 4mg of folate daily beginning at least one month before you become pregnant. This is 10 times the dose that is in regular prenatal vitamins, but you should not take 10 prenatal vitamins to get that dose. Be sure to talk with your urologist, gynecologist, and neurosurgeon (if you have a shunt) about preparing for your pregnancy. There are other issues related to pregnancy for women with Spina Bifida which were discussed in the August 2007 and October 2007 “Ask the Doctor” located in the archives.
As for Ditropan, your doctors are correct that there is nothing published about the effects of this medicine on human pregnancies. Those medicines which have clearly demonstrated problems with pregnancy usually get reported in the medical literature, so we can say that there are no problems commonly identified with ditropan. However, no report of harm does not mean that we can guarantee no harm. We do know women have taken Ditropan during their pregnancy and have delivered healthy babies. The FDA has labeled ditropan as Category B which is the same as many medications commonly prescribed in pregnancy. This means that there are no studies of safety in humans but animals studies (usually rodents) have shown no harm to the fetus.
If you decide to stop using Ditropan during your pregnancy, this will likely cause your bladder to hold less urine, which will get worse as the baby grows in your uterus and presses down on your bladder. You will need to catheterize more frequently to prevent accidents and to decrease the possibility of bladder infections. Bladder infections are not good for you or for the baby so you may want to talk to your gynecologist or urologist about antibiotic suppression. There are antibiotics that are safe to prescribe in pregnancy. Cranberry tablets can make the urine more acidic and less prone to infections but are not a substitute for ditropan to relax the bladder. You will still need to catheterize more frequently if you stop the ditropan.
As for breastfeeding, we do not know if ditropan passes into the breastmilk. Because the medication is an anticholinergic, it can cause drying up of any secretion, including breastmilk. Staying hydrated for the nursing mother may help.
Best wishes on your pregnancy!
Resource: Weiner CP, Buhimschi C. Drugs for Pregnant and Lactating Women - 2nd Edition. Saunders Elsevier. Philadelphia. 2009.
SBA's National Resource Center provides high quality, confidential information and referral services. For more information or to ask a question, please email sbaa@sbaa.org or call 800-621-3141.