The study, published in the journal Neurology, said the risk is particularly high when the drug is used in high doses. “Our results suggest that the increased risk of oral clefts is most pronounced in women taking higher doses of topiramate to treat epilepsy,” said study co-author Elisabetta Patorno of Brigham and Women’s Hospital in Boston, US.
“Low doses of topiramate may also increase the risk of oral clefts but to a lesser extent,” Patorno said. “We hope that this work gives important information to women and their clinicians as they determine the best course of treatment and options available to individuals,” Patorno added. The findings are based on data on more than one million live births over a period of 10 years in the US.
The team examined the risk of oral clefts including cleft palate or cleft lip among three groups infants born to women who had taken topiramate in their first trimester; infants born to women who had taken the drug lamotrigine (an unrelated drug used to treat bipolar disorder and epilepsy); and infants who had not been exposed to anti-epileptic medications in utero.
The researchers found that the risk of oral clefts was approximately three times higher for the topiramate group than for either the lamotrigine or the unexposed group.
“Our results suggest that women with epilepsy on topiramate have the highest relative risk of giving birth to a baby with cleft lip or cleft palate, likely due to the higher doses of topiramate when used for controlling seizures,” said corresponding author Sonia Hernandez-Diaz of the Harvard T.H. Chan School of Public Health. “The best course may be to avoid prescribing high doses of topiramate to women of childbearing age unless the benefits clearly outweigh the risks,” she added. IANS
At the clinic in Rustenburg, nurse Christa Tsomele has been performing abortions for a decade, and says she is proud of her work. She says she thinks some of her colleagues are contributing to the stigma of abortion -- and worse.
Twenty-six-year-old Precious, as she has asked us to call her to protect her identity, is 16 weeks pregnant. And so is her best friend, also by Precious’ boyfriend. That event turned her life upside down and brought her to the difficult decision to seek an abortion.
She lives in South Africa, where abortion is legal without justification and available through a nurse through 12 weeks of pregnancy, and legal up to 20 weeks, when done by a doctor and with justification.
But when she tried to get an abortion in her home city of Johannesburg, she ran into problems.
“When I went to register my name, I simply said, ‘I want to do abortion,’ and then they said, ‘No,’” she told VOA.
“And there were two nurses there, and the older one said, ‘Oh, thank God, I’m not trained for this,’ whilst the other one said, ‘no, you have to do back to your place and do it there.’ Then we had a disagreement there, as, like, I’m being against God and more stuff like that.”
Hers is a common experience, and it’s what reproductive health advocates say drives 10,000 South African women to seek illegal, backstreet abortions every year.
The nation’s health department estimated that as many as 25 percent of maternal deaths from septic miscarriages were the result of such illegal abortions. More than half of all abortions in South Africa are unlicensed, despite the fact that half of all government hospitals offer the service for free.
Precious, who says she fears being judged by her neighbors, chose instead to travel to the dusty mining town of Rustenburg, where aid agency Doctors Without Borders has set up a free abortion clinic.
She said she was sure of her decision.
“I want this thing to be done as quickly as — because I can’t, I can’t take it anymore,” she said, her voice soft and wavering. “Because what I’m thinking is what happened. I can’t think of, like, of positive things. I think, if this thing failed, then what will I do? Should I end my life?”
‘We give women a choice’
Whitney Chinogwenya, head of marketing at South Africa’s best-known private abortion provider, Marie Stopes, says their clinics address a real need. The company recently launched a campaign to try to reduce the stigma around abortion care.
“When a woman wants to terminate a pregnancy, they’re going to terminate the pregnancy,” Chinogwenya told VOA from the organization’s office in downtown Johannesburg. “It doesn’t matter what methods they use, it doesn’t matter whether it’s legal, it’s illegal or it’s safe — they’re going to find a way to terminate the pregnancy.
“So what’s so great about South Africa and it being legal here is that there’s a safe place where you can get the procedure, where it’s not going to harm your body, where it’s not going to cause serious complications. And the most important thing is that we give women a choice.”
Another problem, she said, is that few women know that abortion is legal, and think backstreet providers — who advertise openly, but who are not licensed — are their only option.
Medical experts told VOA harrowing tales of the practices performed by such providers. Many don’t perform ultrasounds, don’t attempt to determine how far along the pregnancy is, don’t follow up after the procedure, give the wrong medication, give incorrect medical advice, or administer dangerous chemicals such as bleach and drain cleaner to desperate patients.
One particularly egregious provider, Chinogwenya told VOA, even tried to sexually assault a woman in his care.
‘Somebody has to do it’
Nurse Kgaladi Mphahlele, who heads the Doctors Without Borders project in Rustenburg, says demand for the clinic’s services is high. He estimates he performs as many as 100 first-trimester abortions each month, and says he sees women from as far away as Botswana, where abortion is illegal.
His patients, he said, range in age from teenagers to 50-year-olds. He began his career delivering babies, but switched course, and says he’s proud of his decision.
“I look back, ‘why did I get myself into this profession?’” he said, adding that his friends and family were initially worried, but have since become supportive of his choice.
“I said, ‘I want to be a health care provider because I want to help the people.’ And then, you see a gap, and this is part of health care service, and if no one is doing it, somebody has to do it. And I enjoy doing it, and I enjoy working with people.”
At the clinic in Rustenburg, nurse Christa Tsomele has been performing abortions for a decade, and says she is proud of her work. She says she thinks some of her colleagues are contributing to the stigma of abortion — and worse.
“If you can’t help a patient as a nurse, just refer the client to the relevant place so that the patient must get help,” she said. “Don’t just tell her, ‘no, I can’t do that, or ‘I can’t help you,’ and leave the patient stranded. That is why they end up going to the bogus [provider]. Because when you leave her stranded, now she decides to go out to the street, that is where she is going to die.”
It’s that, she says, that keeps her going, through the judgment, through the tears, through the difficult stories she hears day in and day out. Because, she says, whether people agree with her work or not, she’s saving women’s lives, and following the law. (VOA)