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首页> 外文期刊>Epilepsia: Journal of the International League against Epilepsy >Antiepileptic drugs during pregnancy: what is known and which AEDs seem to be safest?
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Antiepileptic drugs during pregnancy: what is known and which AEDs seem to be safest?

机译：怀孕期间的抗癫痫药：已知的知识和哪些AED似乎最安全？

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Most infants born to women with epilepsy are healthy, but there are increased risks related to in utero antiepileptic drug (AED) exposure and seizures. Emerging data from pregnancy registries and other studies allow us to better balance the anatomic teratogenic and neurodevelopmental effects of AEDs against the need to maintain maternal seizure control. Several large prospective pregnancy registries demonstrate a consistent pattern of increased risk for major congenital malformations (MCMs) with valproate (VPA) use as monotherapy, compared to nonexposed populations and to other AEDs used in monotherapy. AED polytherapy likely increases risk for MCMs, but the risk is more pronounced if VPA is included. Reduced cognitive outcomes have been reported with AED polytherapy, and with use of VPA, phenobarbital (PB), and PHT as monotherapy. Dose-dependent risk has been demonstrated with VPA for MCMs and cognitive consequences. CBZ groups show normal neurodevelopment. Increased clearance of most of the AEDs occurs during pregnancy. Use of therapeutic drug monitoring during pregnancy with LTG reduces the risk for seizure worsening. The consistent findings of increased teratogenic risk for VPA should discourage use of this medication as first-line treatment in women of childbearing age.
机译：患有癫痫病的妇女所生的大多数婴儿都是健康的，但与子宫内抗癫痫药（AED）暴露和癫痫发作有关的风险增加。来自妊娠登记和其他研究的最新数据使我们能够更好地平衡AED的解剖学致畸和神经发育作用与维持母体癫痫发作控制的需要。与未接触人群和单一疗法中使用的其他AED相比，丙戊酸（VPA）作为单一疗法时，一些大型的前瞻性妊娠登记册显示出重大先天性畸形（MCM）风险增加的一致规律。 AED多联疗法可能会增加MCM的风险，但如果包括VPA，则该风险更为明显。据报道，使用AED多联疗法，以及使用VPA，苯巴比妥（PB）和PHT作为单一疗法时，认知结局降低。 VPA已证明MCM和认知后果的剂量依赖性风险。 CBZ组显示正常的神经发育。在怀孕期间，大多数AED的清除率增加。在怀孕期间使用LTG监测治疗药物可降低癫痫发作恶化的风险。有关VPA致畸风险增加的一致发现，应劝阻这种药物作为育龄妇女的一线治疗。

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