dear doctor, i am attaching a copy of the conversation that i had with Dr. Vidya on the same site. My query remains, should we continue with the pregnancy or not. Will there be any problem-defect for the baby in the hearing or limp growth or eye or anything. Kindly advise, you are our last consultant. Shaiju: hello doctorThis is regarding my wife. She is 28 yrs old and 5.3 my wife is 8 weeks pregnant now. she was using AKT4 at the time of conception and then was moved on to AKT3 till a day back (08.04.2011). We would like to know, if it is advisable to go ahead with the pregnancy. is it going to cause any disability of any kind (hearing, eye, etc.) for the babies (she is conceived with twins) to be born. kindly advise in detail as we are getting different words from many of our offline doctors. We are really concerned and the verge of thinking to terminate. Doctor: Hi Doctor: Dr.Vidya here Shaiju: hello doctor Doctor: Please give me a couple of mins to read your questions Shaiju: sure Doctor: I will help you now , thanks for your patience Shaiju: thank you doctor Doctor: may i know when was she diagnosed with TB ? Shaiju: she was not diagnosed of TB, it was inconclusive Shaiju: she was diagnosed with granulumatous lymphadenitis Doctor: ok Doctor: when was this ? Shaiju: for which the doctors could not find any dead or live bacteria Shaiju: this was in october 2010 Doctor: ok Doctor: when did she start the medicines Shaiju: november 2010 Doctor: ok Doctor: was she on AKT4 regularly ? Shaiju: then she had stopped for sometime Doctor: ok Doctor: when was the conception exactly diagnosed ? Shaiju: yes continuously for three months starting december Shaiju: yes we have done a scan and also a blood test too. Doctor: ok , when was the pregnancy confirmed? Doctor: can you give me the dates Shaiju: 07/04/2011 Shaiju: we didn t know that she was pregnant before that Doctor: ok Shaiju: when it was diagnosed it was already 7.5 weeks Doctor: have you taken an opinion about this from a consultant gynecologist ? Shaiju: one fetus and another 7.6 weeks Shaiju: yes Doctor: what did the doctor opine ? Shaiju: she is not able to ascertain if there would be any effect on the fetus or not Shaiju: so she is suggesting termination Shaiju: we also consulted a pediatrician, he is in the opinion that the child might have problem with the hearing Doctor: ok Doctor: let me explain it to you Doctor: the drugs for TB include isoniazid , pyrizinamide , ethambutol and rifamipicin Doctor: all of them are grouped under CATEGORY C Doctor: under the pregnancy and lactation drugs list Shaiju: what does the category c mean doctor Doctor: We have something called FDA categories in pregnancy which we follow Doctor: i will tell uoi Doctor: you* Doctor: for example : we have 5 categories called A,B,C,D,X Shaiju: ok Doctor: Controlled studies show no risk. Adequate, well-controlled studies in pregnant women have failed to demonstrate risk to the fetus this is for category A Doctor: No evidence of risk in humans. Either animal findings show risk, but human findings do not; or if no adequate human studies have been done, animal findings are negative this is for CAT B Doctor: Risk cannot be ruled out. Human studies are lacking, and animal studies are either positive for fetal risk or lacking. However, potential benefits may justify the potential risks THIS IS FOR CAT C which the drugs taken fall under Doctor: since this says risks cannot be ruled out Doctor: but human studies have not shown risks so far Doctor: i would give 60 /40 chances Doctor: many doctors do not ask to terminate the pregnancy Doctor: but some doctors do suggest for termination if it is stillin early weeks Doctor: this is a situation of weighing risk over benifits Shaiju: is this going to be the case even in the case of twins Doctor: yes , it includes same for twins as well Doctor: may i know if it is the first child ? Shaiju: yes this is our first Shaiju: we are unable to make a strong decision Doctor: i know this is a situation which needs a lot of thinking Doctor: it may or may not harm the child Doctor: there is no significant evidence so far that there will be problems in the child Doctor: with the medicines she is on Doctor: if she had taken STREPTOMYCIN Doctor: there were possibilities of having a hearing defect Doctor: as I told you the classification also Doctor: it does not rule out chances of risk , but also says it can be given in pregnancy Doctor: it is upto you to make the decision Doctor: I suggest you take a second opinion Shaiju: what are the possible defects that we can expect, if there would be any Doctor: from a good obstretician Doctor: with these drugs , there are not much which has been reported , but very rarely one can see vision problems in the child like color defects Doctor: and also bleeding problems at birth Shaiju: ok doctor Doctor: so i recommend a second opinion Shaiju: could those defects if treated if needed Doctor: you can compare and contrast Doctor: it depends on the level of damage to the eye and other organs Shaiju: will the bleeding affect the mother badly during pregnancy Doctor: it would be difficult for me to say upto what level it causes a damage Doctor: the bleeding can be pevented with supplement vitamins called pyridoxine in pregnancy Doctor: it will not be so severe also Shaiju: whats the percentage of complication in pregnancy Doctor: very rarely limb malformation , kidney malformation , hip dislocation have been reported in some cases , very very few cases so far Doctor: it will not affect the mother Doctor: as such taking AKT4 in pregnancy will notcomplicate the pregnancy if taken under guidance of a good speciailist Shaiju: ok doctor Doctor: so I SUGGEST YOU DISCUSS THIS WITH THE GYNECOLOGIST Shaiju: do we get to talk to a obstretician on this website Doctor: probabaly a second opinion Doctor: yes , you have a phone service as well as mail service for seeking a specialist opinion Doctor: do you want to avail it Doctor: Dr. Chetna JainM.D, M.R.C.O.G., UK Board certification in Obstetrics and Gynaecology. WWW.WWWW.WW Shaiju: i will try that doctor Doctor: she is in our panel Doctor: you can call our customer team Doctor: or mail us @doctor@healthcaremagic Shaiju: sure thanks Shaiju: doctor Doctor: YYYY@YYYY Doctor: seeking a specialist opinion Shaiju: we appreciate your help. Doctor: you can talk through phone with her or other gynecologist or mail them Doctor: you will get a reply with in 48 hrs Doctor: i hope i was of some help to you Doctor: thanks for consulting me
Hello there, thanks for the query. I appreciate your deepest concern for your unborn children and painstaking effort to get as many opinions as you get. I hope you haven't jumped into hasty decisions by the time you receive this answer. First of all, AKT4 contains 4 drugs that are rifampicin, isoniazid, ethambutol, pyrazinamide.All these are first line drugs for tuberculosis.Let's consider one by one,1. Isoniazid belongs to category A drug and is considered safe in pregnancy.2. Pyrazinamide is a category B2 drug which means no studies has been done or data is available regarding its safety but fetal malformations aren't reported. WHO and International Union against TB and Lung diseases support its use in pregnancy although Centre for Disease Control(CDC) says it can probably be used safely in pregnancy.3. Rifampicin is category C drug and is considered safe to use in pregnancy by WHO.Bleeding side effect in newborn and the mother is related to its use in last few weeks of pregnancy and can be prevented by using vitamin k injections.4.Ethambutol is category A drug and safe to use in pregnancy.  P.S-There are very rare risks associated with these drugs. But it doesn't strictly warrant termination of pregnancy. Hope this helps. Enjoy your parenthood with utmost joy. All the best.