Management issues for women with epilepsy
Management issues for women with epilepsy
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DOI：
10.1212/wnl.61.6_suppl_2.s23
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发表时间：
2003-09
期刊：
影响因子：
9.9
通讯作者：
M. Yerby
中科院分区：
文献类型：
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作者：
M. Yerby
对于在子宫内暴露于抗癫痫药物（AED）的婴儿，先天性畸形的风险约为4%至6%，是一般人群中报告的比率的两倍。据报道，各种畸形与产前暴露于AED有关。然而，已经确定了丙戊酸盐和卡马西平与神经管缺陷（NTD）的特定相关性-特别是与开放性脊柱裂（SB）的相关性。丙戊酸盐暴露的SB患病率约为1 - 2%，卡马西平暴露的SB患病率约为0.5%。报告的NTD的危险因素包括以前怀孕NTD，母亲胰岛素依赖型糖尿病，各种营养不良和职业暴露，以及孕前体重偏高。叶酸缺乏与包括NTD在内的出生缺陷的发生有关。在一般人群中，妇女围受孕期补充叶酸的价值是公认的。然而，目前还不清楚叶酸补充剂是否可以防止AED的胚胎毒性和致畸作用，因为动物和人类研究以及病例报告显示了不同的结果。尽管如此，叶酸补充建议癫痫妇女，因为它是为其他育龄妇女。即使补充叶酸，服用丙戊酸盐或卡马西平的妇女也应进行围产期诊断超声检查，以排除NTD。
For infants exposed to antiepileptic drugs (AEDs) in utero, the risk for congenital malformations is approximately 4 to 6%, twice the rate reported in the general population. A variety of malformations have been reported in association with prenatal exposure to AEDs. However, a particular association of valproate and carbamazepine with neural tube defects (NTDs)—specifically, with spina bifida aperta (SB)—has been identified. The prevalence of SB is approximately 1 to 2% with valproate exposure and 0.5% with carbamazepine. Reported risk factors for NTDs include previous pregnancy with an NTD, maternal insulin-dependent diabetes mellitus, various nutritional deficiencies and occupational exposures, and high prepregnancy weight. Deficiencies of folate have been implicated in the development of birth defects, including NTDs. The value of periconceptional folic acid supplementation for women in the general population is accepted. However, it is unclear whether folic acid supplementation protects against the embryotoxic and teratogenic effects of AEDs because animal and human studies and case reports have shown variable results. Nevertheless, folic acid supplementation is recommended for women with epilepsy as it is for other women of childbearing age. Even with supplementary folic acid, women taking valproate or carbamazepine should undergo perinatal diagnostic ultrasound to rule out NTDs.