抗癫药物对妊娠癫癎患者子代的致畸风险

目的:旨在评估抗癫癎药物(AEDs)对妊娠癫癎患者子代出现先天畸形的风险。方法:对妊娠癫癎患者采用登记和随访研究,分析其孕期AEDs用药情况、癫癎发作、妊娠结局及子代出现畸形的风险。结果:入选105例妊娠癫癎患者。服用AEDs患者79/105例(75.2%),未服用AEDs患者26/105例(24.8%)。单药治疗60/79例(75.9%),其中1/60例(1.7%)流产;患者子代中2/60例(3.3%)先天性畸形(1例服用卡马西平,出现先天性心脏动脉导管未闭;1例服用拉莫三嗪,出现无胚心)。联合用药19/79例(24.1%),子代无先天畸形出现。未服用AEDs患者中有2/26例(7.7%)流产,其余患者子代未出现先天畸形。结论:妊娠癫癎孕妇多数于孕期仍服用AEDs,且以单药治疗居多;使用AEDs(分别为卡马西平和拉莫三嗪)患者子代出现2例先天性畸形;丙戊酸钠易致畸但仍在妊娠癫癎中经常使用,本研究中服用丙戊酸钠孕妇未出现子代先天性畸形。

The Teratogenic Risk of the Antiepileptic Drugs on Fetus of the Pregnant Women with Epilepsy

Aim： To assess the teratogenic risk of the antiepileptic drugs on fetus of pregnant women with epilepsy. Methods： A prospective, registering, follow-up study was used to analyze the medication, epileptic attack, fetal health status and pregnancy outcome of early pregnant women with epilepsy. Results： 105 cases were studied. 79 cases （75.2%） took antiepileptic drugs. 26 cases （24.8%） didn＇t take AEDs prior to pregnancy. 60 cases （75.9%） were exposed to anti-epileptic drug monotherapy during pregnancy, with one case （1.7%） of abortion. Of the patients exposed to AEDs monotherapy, there were 2 cases （3.3%） whose children had congenital malformations. Of the 19 cases （24.1%） exposed to AEDs polytherapy, there was no case whose child appearing congenital malformations. Of the cases that didn＇ t take AEDs, there were 2 cases of abortion, There was no case whose child appearing congenital malformations. Conclusion： The majority of women suffering from epilepsy was treated with AEDs monotherapy rather than polytherapy during pregnancy. There were 2 cases with congenital malformations, whose mothers were exposed to AED monotherapy （1 case carbamazepine, 1 case lamotrigine）. Though valproate was now still used in pregnant women with epilepsy despite of its teratogenicity, there was no case whose child appearing congenital malformations.