Yerby Mark S
North Pacific Epilepsy Research, Portland, Oregon 97210, USA.
Epilepsia. 2003;44 Suppl 3:33-40.
Women with epilepsy (WWE) have a risk of bearing children with congenital malformations that is approximately twice that of the general population. Most antiepileptic drugs (AEDs) have been associated with such risk. Valproate and carbamazepine have been associated specifically with the development of neural tube defects (NTDs), especially spina bifida. Other factors may contribute to the risk, including concomitant diseases such as diabetes mellitus, occupational exposure to teratogens, excessive prepregnancy weight, and various nutrient deficiencies. In the general population, maternal folate deficiency, in particular, has been linked with the development of NTDs, and periconceptional folate supplementation with a reduction of risk. It is unclear whether folate supplementation has a comparable protective effect for WWE. Data concerning the risk for congenital malformations associated with the newer AEDs (gabapentin, felbamate, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, and zonisamide) are still limited. Several pregnancy registries for women taking AEDs have been established. Comprehensive postmarketing surveillance, regionally or nationally, might be the ideal method of monitoring medication safety, but government support for such an undertaking has for the most part been lacking. Despite uncertainty about the efficacy of periconceptional folate supplementation in WWE, these women should receive such supplementation at dosage levels recommended for the general population of women of childbearing age. Seizure control must not be neglected in a pregnant woman with epilepsy since seizures are associated with harm to the fetus as well as the mother. Risk may be minimized by using a single AED at the lowest effective dosage.
癫痫女性（WWE）生育先天性畸形患儿的风险约为普通人群的两倍。大多数抗癫痫药物（AEDs）都与这种风险相关。丙戊酸盐和卡马西平尤其与神经管缺陷（NTDs）的发生有关，特别是脊柱裂。其他因素也可能导致这种风险，包括糖尿病等伴随疾病、职业性接触致畸剂、孕前体重过重以及各种营养素缺乏。在普通人群中，特别是孕妇叶酸缺乏与神经管缺陷的发生有关，而孕前补充叶酸可降低风险。目前尚不清楚叶酸补充剂对癫痫女性是否具有类似的保护作用。关于新型抗癫痫药物（加巴喷丁、非氨酯、拉莫三嗪、左乙拉西坦、奥卡西平、噻加宾、托吡酯和唑尼沙胺）相关先天性畸形风险的数据仍然有限。已经建立了几个针对服用抗癫痫药物女性的妊娠登记处。在区域或国家层面进行全面的上市后监测可能是监测药物安全性的理想方法，但政府在很大程度上缺乏对此类工作的支持。尽管癫痫女性孕前补充叶酸的效果尚不确定，但这些女性应按照育龄女性普通人群推荐的剂量水平接受此类补充。癫痫孕妇的癫痫控制绝不能忽视，因为癫痫发作对胎儿和母亲都会造成伤害。通过使用最低有效剂量的单一抗癫痫药物，风险可降至最低。
