Long term health and neurodevelopment in children exposed to antiepileptic drugs before birth
Long term health and neurodevelopment in children exposed to antiepileptic drugs before birth
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DOI：
10.1136/jmg.39.4.251
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发表时间：
2002-04-01
影响因子：
4
通讯作者：
Little, J
中科院分区：
文献类型：
--
作者：
Dean, JCS;Hailey, H;Little, J
目的：探讨子宫内暴露于抗癫痫药物的新生儿及儿童后期发病情况。设计：基于人群的回顾性研究。背景：苏格兰格兰扁平原地区的人口。参与者：从医院产科记录中确定了1976年至2000年间怀孕期间服用抗癫痫药物的母亲，共有149名（占符合条件的58%）参加了研究。他们对293名儿童的健康和神经发育进行了评估。主要结果测量：新生儿戒断、先天性畸形、儿童期发病的医疗问题、发育迟缓和行为障碍的频率。结果：接触抗癫痫药物的新生儿中有20%出现戒断反应。与未暴露于辐射的同胞相比，14%的暴露于辐射的孕妇出现先天性畸形，24%的暴露于辐射的儿童出现发育迟缓，而未暴露于辐射的同胞的这一比例为11%。在排除有发育迟缓家族史的病例后，19%的接触者儿童和3%的未接触者儿童有发育迟缓，24%的接触者儿童有严重畸形或发育迟缓，52%的接触者儿童有面部畸形，而未接触者的这一比例为25%，31%的接触者儿童有儿童医疗问题（未接触者占13%），20%有行为障碍（未接触者占5%）。结论：在母体癫痫的情况下，产前抗癫痫药物暴露除了与先天性畸形有关外，还与发育迟缓和儿童后期发病率有关。
Objective: To investigate the frequency of neonatal and later childhood morbidity in children exposed to antiepileptic drugs in utero.Design: Retrospective population based study.Setting: Population of the Grampian region of Scotland.Participants: Mothers taking antiepileptic drugs in pregnancy between 1976 and 2000 were ascertained from hospital obstetric records and 149 (58% of those eligible) took part. They had 293 children whose health and neurodevelopment were assessed.Main outcome measures: Frequencies of neonatal withdrawal, congenital malformations, childhood onset medical problems, developmental delay, and behaviour disorders.Results: Neonatal withdrawal was seen in 20% of those exposed to antiepileptic drugs. Congenital malformations occurred in 14% of exposed pregnancies, compared with 5% of non-exposed sibs, and developmental delay in 24% of exposed children, compared with 11% of non-exposed sibs. After excluding cases with a family history of developmental delay, 19% of exposed children and 3% of non-exposed sibs had developmental delay, 24% of exposed children had either major malformations or developmental delay, 52% of exposed children had facial dysmorphism compared with 25% of those not exposed, 31% of exposed children had childhood medical problems (13% of non-exposed sibs), and 20% had behaviour disorders (5% of non-exposed).Conclusion: Prenatal antiepileptic drug exposure in the setting of maternal epilepsy is associated with developmental delay and later childhood morbidity in addition to congenital malformation.