Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): II. Teratogenesis and perinatal outcomes

被引：170

作者：

Harden, Cynthia L. ^{[1
]}

Meador, Kimford J. ^{[2
]}

Pennell, Page B. ^{[2
]}

Hauser, W. Allen ^{[3
]}

Gronseth, Gary S. ^{[4
]}

French, Jacqueline A. ^{[5
]}

Wiebe, Samuel ^{[6
]}

Thurman, David ^{[7
]}

Koppel, Barbara S. ^{[8
]}

Kaplan, PeterW. ^{[9
]}

Robinson, Julian N. ^{[10
]}

Hopp, Jennifer ^{[11
]}

Ting, Tricia Y. ^{[11
]}

Gidal, Barry ^{[12
,13
]}

Hovinga, Collin A.

Wilner, Andrew N.

Vazquez, Blanca

Holmes, Lewis ^{[10
]}

Krumholz, Allan ^{[11
]}

Finnell, Richard ^{[14
]}

Hirtz, Deborah ^{[15
]}

Le Guen, Claire ^{[16
]}

机构：

[1] Univ Miami, Miami, FL USA

[2] Emory Univ, Atlanta, GA 30322 USA

[3] Columbia Univ, New York, NY USA

[4] Univ Kansas, Med Ctr, Kansas City, KS 66103 USA

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

[6] Univ Calgary, Calgary, AB, Canada

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

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

[9] Johns Hopkins Univ, Baltimore, MD USA

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

[11] Univ Maryland, Baltimore, MD 21201 USA

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

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

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

[15] NINDS, Bethesda, MD 20892 USA

[16] Univ Penn, Philadelphia, PA 19104 USA

来源：

EPILEPSIA | 2009年 / 50卷 / 05期

关键词：

Guideline; Pregnancy; Epilepsy; Antiepileptic drugs; Teratogenesis; Major congenital malformations; Apgar score; Small for gestational age; ANTIEPILEPTIC DRUGS; IN-UTERO; CONGENITAL-MALFORMATIONS; PSYCHOMOTOR DEVELOPMENT; MATERNAL EPILEPSY; PRENATAL EXPOSURE; CHILDREN; INTELLIGENCE; VALPROATE; PHENYTOIN;

D O I：

10.1111/j.1528-1167.2009.02129.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 antiepileptic drug (AED) teratogenicity and adverse perinatal outcomes. It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine (CBZ), and possibly compared to phenytoin (PHT) or lamotrigine (LTG). It is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. AED polytherapy probably contributes to the development of MCMs and reduced cognitive outcomes compared to monotherapy. Intrauterine exposure to VPA monotherapy probably reduces cognitive outcomes and monotherapy exposure to PHT or phenobarbital (PB) possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of < 7. If possible, avoidance of VPA and AED polytherapy during the first trimester of pregnancy should be considered to decrease the risk of MCMs. If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered and avoidance of PHT and PB throughout pregnancy may be considered to prevent reduced cognitive outcomes.

引用

页码：1237 / 1246

页数：10

共 46 条

[1] The longer term outcome of children born to mothers with epilepsy [J].