Champel V, Radal M, Moulin-Vallez M, Jonville-Béra A P, Autret-Leca E
Service de Pharmacologie Clinique et Centre Régional de Pharmacovigilance et de Renseignements sur le Médicament du C.H.U. de Tours.
Rev Neurol (Paris). 1999 Mar;155(3):220-4.
Fetal exposure to valproic acid or carbamazepine increases the risk of neural tube defect (NTD). The risk of a mother having a baby with spina bifida has been estimated at 1-2 p. 100, close to the rate of risk of recurrent cases. No study has evaluated the effect of folic acid in neonates of women treated with valproic acid or carbamazepine although the protective effect against NTD has been proven in other populations. Periconceptional folic acid supplementation, 0.4 to 1 mg/day, for at least one month prior to conception and until the date of the second missed menstrual period or later decreases the incidence of a first occurrence of neural tube defect. Periconceptional folic acid supplementation, 4 mg/day, decreases the recurrence of NTD in women who had previously had a child with NTD. It seems pertinent to recommend periconceptional folic acid supplementation in women treated with carbamazepine or valporic acid. There are very few data in women on which to base a decision to advise taking 4 mg/day (as used in recurrence prevention) or low doses of 0.4 mg/day (used in primary prevention).
胎儿暴露于丙戊酸或卡马西平会增加神经管缺陷（NTD）的风险。母亲生下患有脊柱裂婴儿的风险估计为1 - 2‰，接近复发病例的风险率。尽管叶酸对NTD的保护作用已在其他人群中得到证实，但尚无研究评估叶酸对接受丙戊酸或卡马西平治疗的女性新生儿的影响。孕前补充叶酸，每天0.4至1毫克，在受孕前至少一个月开始，直至第二次月经推迟日期或更晚，可降低首次发生神经管缺陷的发生率。孕前补充叶酸，每天4毫克，可降低既往有过NTD患儿的女性NTD的复发率。建议接受卡马西平或丙戊酸治疗的女性在孕前补充叶酸似乎是合理的。关于建议服用4毫克/天（用于预防复发）或低剂量0.4毫克/天（用于一级预防）的数据非常少，难以据此做出决策。
