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Pregabalin and pregnancy
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DEAR DR. ROACH: I’m 13 weeks pregnant, and I am on pregabalin (prescribed off-label for anxiety). I asked my GP if it is safe to continue to be on it while pregnant, and he was very dismissive and hurried me out the door without really telling me anything. I read about a very small study that was conducted that seemed to show a risk of birth defects, but due to its small size, it didn’t really help me either. I was wondering if you know anything about pregabalin and pregnancy. -- G.H.

ANSWER: While I understand the demands of a busy practice, your physician should have found time to talk to you about this important issue.

A study from Boston in 2017 looked at a large database and found no statistically significant increase in major congenital abnormalities in women taking pregabalin during pregnancy, but it could not exclude the possibility of a small risk of a harmful effect. Anxiety itself isn’t good for the baby, so the best option would be treatment that is effective but at lowest risk. It has been my experience that many women want to avoid the slightest chance of damage to their developing baby from medication, but my job often is to help them consider also the risks of not taking medicine. In your case, given the large number of medicines for anxiety that are better studied in pregnancy, I would talk to your doctor about a different choice during pregnancy. Benzodiazepines (including Valium, Ativan and others) are seldom my first choice for anxiety, but they are the first choice among many experts in treating anxiety during pregnancy.

DEAR DR. ROACH: I’m a 76-year-old woman. After having a discharge from my right nipple twice for the first time last August (I have family history of breast cancer -- my mom and her three sisters), I had to undergo a mammogram, and then had an ultrasound where they found four more cysts (two cysts were from years ago). A week later, I had a needle biopsy for all four, along with adding four markers, and they came back benign, which was good news.  They said to be sure to get my routine mammogram next August, which I will.  But, my question to you is why have I had a clear, yellowish nipple discharge two to three times since then (the last discharge was last week, four months after my breast biopsies).  Is this normal, or do I need to get a second opinion or go through this ordeal again in case they made a mistake? -- C.D.

   ANSWER: This is not normal. Discharge from one nipple is considered pathological, and it needs to be further evaluated.

   The most common cause of nipple discharge in a post-menopausal woman is a papilloma of the breast, and although these are benign tumors, some contain atypical cells or another condition, ductal carcinoma-in-situ, which is a type of breast cancer.

   The reason you need further evaluation is not that they may have made a mistake, but rather that they haven’t yet made a diagnosis. The fact that the mammogram and biopsies are negative is reassuring, but incomplete.

Most breast surgeons would perform a breast procedure called a terminal duct excision, which should both stop the discharge and make a definitive diagnosis. I recommend a visit with a breast surgeon.