Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): III. Vitamin K, folic acid, blood levels, and breast-feeding

被引：105

作者：

Harden, Cynthia L. ^{[1
]}

Pennell, Page B. ^{[2
]}

Koppel, Barbara S. ^{[3
]}

Hovinga, Collin A. ^{[4
]}

Gidal, Barry ^{[5
]}

Meador, Kimford J. ^{[2
]}

Hopp, Jennifer ^{[6
]}

Ting, Tricia Y. ^{[6
]}

Hauser, W. A. ^{[7
]}

Thurman, David ^{[8
]}

Kaplan, Peter W. ^{[9
]}

Robinson, Julian N. ^{[10
]}

French, Jacqueline A. ^{[11
]}

Wiebe, Samuel ^{[12
]}

Wilner, Andrew N.

Vazquez, Blanca ^{[11
]}

Holmes, Lewis ^{[10
]}

Krumholz, Allan ^{[6
]}

Finnell, Richard ^{[13
]}

Shafer, Patricia O. ^{[14
]}

Le Guen, Claire L. ^{[15
]}

机构：

[1] Univ Miami, Miami, FL USA

[2] Emory Univ, Atlanta, GA 30322 USA

[3] New York Med Coll, New York, NY USA

[4] Univ Tennessee, Ctr Hlth Sci, Memphis, TN 38163 USA

[5] Univ Wisconsin, Sch Pharm, Madison, WI 53706 USA

[6] Univ Maryland, Baltimore, MD 21201 USA

[7] Columbia Univ, New York, NY USA

[8] Ctr Dis Control & Prevent, Atlanta, GA USA

[9] Johns Hopkins Univ, Baltimore, MD USA

[10] Harvard Univ, Sch Med, Boston, MA USA

[11] NYU, Sch Med, New York, NY USA

[12] Univ Calgary, Calgary, AB, Canada

[13] Texas A&M Univ, Hlth Sci Ctr, Houston, TX USA

[14] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[15] Univ Penn, Philadelphia, PA 19104 USA

来源：

EPILEPSIA | 2009年 / 50卷 / 05期

关键词：

Guideline; Pregnancy; Epilepsy; Antiepileptic drugs; Folic acid; Vitamin K; ANTIEPILEPTIC DRUGS; PLACENTAL-TRANSFER; NURSED INFANTS; PROTEIN-BINDING; VALPROIC ACID; PLASMA-CONCENTRATIONS; MAJOR MALFORMATIONS; FETAL ACCUMULATION; LACTATION PERIOD; NEONATAL-PERIOD;

D O I：

10.1111/j.1528-1167.2009.02130.x

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

A committee assembled by the American Academy of Neurology (AAN) reassessed the evidence related to the care of women with epilepsy (WWE) during pregnancy, including preconceptional folic acid and prenatal vitamin K use and the clinical implications of placental and breast-milk transfer of antiepileptic drugs (AEDs). The committee evaluated the available evidence based on a structured literature review and classification of relevant articles. Preconceptional folic acid supplementation is possibly effective in preventing major congenital malformations in the newborns of WWE taking AEDs. There is inadequate evidence to determine if the newborns of WWE taking AEDs have a substantially increased risk of hemorrhagic complications. Primidone and levetiracetam probably transfer into breast milk in clinically important amounts. Valproate, phenobarbital, phenytoin, and carbamazepine probably are not transferred into breast milk in clinically important amounts. Pregnancy probably causes an increase in the clearance and a decrease in the concentrations of lamotrigine, phenytoin, and, to a lesser extent carbamazepine, and possibly decreases the level of levetiracetam and the active oxcarbazepine metabolite, the monohydroxy derivative (MHD). Supplementing WWE with at least 0.4 mg of folic acid before pregnancy may be considered. Monitoring of lamotrigine, carbamazepine, and phenytoin levels during pregnancy should be considered, and monitoring of levetiracetam and oxcarbazepine (as MHD) levels may be considered. A paucity of evidence limited the strength of many recommendations.

引用

页码：1247 / 1255

页数：9

共 45 条

[1] SERUM PHENYTOIN DURING PREGNANCY, LABOR AND PUERPERIUM [J].