Risks during pregnancy in women with epilepsy.
Risks during pregnancy in women with epilepsy.
复制标题
癫痫女性怀孕期间的风险。
DOI：
10.1016/s0140-6736(15)00047-1
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Meador,KimfordJ
中科院分区：
文献类型：
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作者：
Meador,KimfordJ
自2000年以来，有大量关于癫痫妇女妊娠结局的新信息。这些信息大部分与胎儿暴露于抗癫痫药物的癫痫女性的子女发生重大先天性畸形和认知行为缺陷的风险有关。1-3这些研究强调了宫内暴露于丙戊酸盐的儿童发生重大先天性畸形、认知障碍和自闭症谱系障碍的风险（1岁时为9.3%）。1-7主要先天性畸形的中等风险与胎儿苯巴比妥（5.5%）和托吡酯（4.2%）暴露有关。1，2，4主要先天畸形的低风险与卡马西平（2.9%）、拉莫三嗪（2.0%）、左乙拉西坦（2.4%）和奥卡西平（2.2%）的暴露相关。1，2，4据报道，卡马西平、拉莫三嗪和左乙拉西坦的认知问题风险较低，与未暴露人群无统计学差异。6，8大多数抗癫痫药物和多种疗法的风险是不确定的。关于癫痫女性的其他妊娠风险的信息甚至更少，个别研究导致了不同和不精确的风险估计。美国神经病学学会（AAN）回顾了2009年的科学文献和出版的实践参数，其中指出，服用抗癫痫药物的癫痫妇女的剖腹产，晚期妊娠出血或早产和分娩的风险可能没有实质性增加。2在怀孕前9个月内没有癫痫的癫痫妇女在怀孕期间可能保持无癫痫。2 AAN审查小组得出结论，需要强有力的证据来确定是否有增加的风险，
Since 2000, a great deal of new information has become available about pregnancy outcomes in women with epilepsy. Most of this information has been related to the risks of major congenital malformations and cognitive behavioural deficits in children of women with epilepsy who had fetal antiepileptic drug exposure. 1–3 These studies have emphasised the risks of major congenital malformations, cognitive impairment, and autistic spectrum disorder for children exposed in utero to valproate (9· 3% at 1 year of age). 1–7 Intermediate risks for major congenital malformations have been associated with fetal phenobarbital (5· 5%) and topiramate (4· 2%) exposures. 1, 2, 4 Low risks for major congenital malformations have been associated with exposure to carbamazepine (2· 9%), lamotrigine (2· 0%), levetiracetam (2· 4%), and oxcarbazepinem (2· 2%). 1, 2, 4 Low risks for cognitive problems have been reported for carbamazepine, lamotrigine, and levetiracetam, which do not differ statistically from the unexposed population. 6, 8 The risks for most antiepileptic drugs and polytherapies are uncertain.Even less information is available for other pregnancy risks in women with epilepsy, and individual studies have resulted in varied and imprecise estimates of risks. The American Academy of Neurology (AAN) reviewed the scientific literature and published practice parameters in 2009, which stated that probably no substantially increased risk exists of caesarean delivery, late pregnancy bleeding, or premature labour and delivery in women with epilepsy who are taking antiepileptic drugs. 2 Women with epilepsy who were seizure-free during the 9 months before conception are likely to stay seizure-free during pregnancy. 2 The AAN review group concluded that strong evidence is needed to establish if there are increased risks for a variety