Management of Anti-Seizure Medications during Pregnancy: Advancements in The Past Decade.
Management of Anti-Seizure Medications during Pregnancy: Advancements in The Past Decade.
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怀孕期间抗塞氏菌药物的管理：过去十年的进步。
DOI：
10.3390/pharmaceutics14122733
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发表时间：
2022-12-06
期刊：
影响因子：
5.4
通讯作者：
Birnbaum, Angela K.
中科院分区：
文献类型：
--
作者：
Avachat, Charul;Barry, Jessica M.;Lyu, Xintian;Sherwin, Catherine M.;Birnbaum, Angela K.
癫痫发作的治疗通常涉及患者一生中持续用药，包括患者怀孕期间。怀孕期间的生理变化可能会导致抗癫痫药物的药物暴露发生变化，从而增加患者反应的变异性。此外，母亲体内低于治疗剂量的抗癫痫药物浓度可能会增加癫痫发作频率，从而增加流产和早产的风险。另一方面，药物暴露的增加可能导致发育中胎儿神经发育结果的差异。已建立的妊娠登记可以深入了解抗癫痫药物使用的致畸潜力。此外，一些抗癫痫药物与严重先天畸形的风险增加有关，其使用在过去十年中有所下降。虽然较新的抗癫痫药物一般被认为具有更有利的药代动力学，但它们并非没有风险，因为当个体怀孕时，它们可能会发生显着的药代动力学变化。鉴于妊娠期间代谢和肾功能的已知变化，药物浓度的治疗监测有助于确定是否以及何时应改变剂量，以维持与孕前观察到的类似的癫痫发作控制。本综述重点关注过去十年（2010-2022）关于严重先天畸形风险、处方模式变化以及为妊娠癫痫患者开具的抗癫痫药物的药代动力学的研究结果。
Management of seizures often involves continuous medication use throughout a patient’s life, including when a patient is pregnant. The physiological changes during pregnancy can lead to altered drug exposure to anti-seizure medications, increasing patient response variability. In addition, subtherapeutic anti-seizure medication concentrations in the mother may increase seizure frequency, raising the risk of miscarriage and preterm labor. On the other hand, drug exposure increases can lead to differences in neurodevelopmental outcomes in the developing fetus. Established pregnancy registries provide insight into the teratogenicity potential of anti-seizure medication use. In addition, some anti-seizure medications are associated with an increased risk of major congenital malformations, and their use has declined over the last decade. Although newer anti-seizure medications are thought to have more favorable pharmacokinetics in general, they are not without risk, as they may undergo significant pharmacokinetic changes when an individual becomes pregnant. With known changes in metabolism and kidney function during pregnancy, therapeutic monitoring of drug concentrations helps to determine if and when doses should be changed to maintain similar seizure control as observed pre-pregnancy. This review concentrates on the results from research in the past decade (2010–2022) regarding risks of major congenital malformations, changes in prescribing patterns, and pharmacokinetics of the anti-seizure medications that are prescribed to pregnant patients with epilepsy.
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