Kaaja Erja, Kaaja Risto, Hiilesmaa Vilho
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Huch, Finland.
Neurology. 2003 Feb 25;60(4):575-9. doi: 10.1212/01.wnl.0000044157.28073.dc.
The offspring of women with epilepsy are at an increased risk of major congenital malformations, but the impact of the various contributing factors remains unresolved.
In 1980 through 1998, the authors prospectively followed up 970 pregnancies in women with epilepsy at a single maternity clinic. Of their 979 offspring, 740 were exposed to maternal antiepileptic drugs (AED) during the first trimester of pregnancy and 239 were not exposed. Maternal AED levels and serum folate concentrations were measured at the end of the first trimester. Logistic regression analysis was applied to identify factors associated with the occurrence of major malformations in the fetuses and newborns.
Major malformations were detected in 28 fetuses (3.8%) exposed to maternal AED and in 2 (0.8%) not exposed (p = 0.02). After logistic regression analysis, the occurrence of major malformations was independently associated with use of carbamazepine (adjusted OR 2.5; 95% CI 1.0 to 6.0), use of valproate (4.1; 1.6 to 11), use of oxcarbazepine (10.8; 1.1 to 106), low serum folate concentration (5.8; 1.3 to 27), and low maternal level of education (3.0; 1.3 to 6.8). Major malformations were not associated with seizures during the first trimester (0.6; 0.1 to 2.9).
Major malformations in the offspring of mothers with epilepsy are associated with use of AED during early pregnancy, and also with low serum folate concentrations and a low level of education.
癫痫女性的后代患重大先天性畸形的风险增加，但各种促成因素的影响仍未明确。
1980年至1998年，作者在一家单一的产科诊所对970例癫痫女性的妊娠进行了前瞻性随访。在她们的979名后代中，740名在妊娠头三个月接触了母体抗癫痫药物（AED），239名未接触。在妊娠头三个月末测量了母体AED水平和血清叶酸浓度。应用逻辑回归分析来确定与胎儿和新生儿重大畸形发生相关的因素。
在接触母体AED的28名胎儿（3.8%）和未接触的2名胎儿（0.8%）中检测到重大畸形（p = 0.02）。经过逻辑回归分析，重大畸形的发生与卡马西平的使用（调整后的OR 2.5；95% CI 1.0至6.0）、丙戊酸盐的使用（4.1；1.6至11）、奥卡西平的使用（10.8；1.1至106）、血清叶酸浓度低（5.8；1.3至27）以及母亲教育水平低（3.0；1.3至6.8）独立相关。重大畸形与妊娠头三个月的癫痫发作无关（0.6；0.1至2.9）。
癫痫母亲后代的重大畸形与妊娠早期使用AED有关，也与血清叶酸浓度低和教育水平低有关。
