Gladstone D J, Bologa M, Maguire C, Pastuszak A, Koren G
Motherisk Program, Hospital for Sick Children, Toronto, Ontario, Canada.
Reprod Toxicol. 1992;6(3):257-61. doi: 10.1016/0890-6238(92)90181-r.
This prospective study followed the pregnancy course of epileptic women at the Motherisk Program of The Hospital for Sick Children, Toronto. We compared fetal outcome of women treated with carbamazepine (CBZ), those treated with diphenylhydantoin (phenytoin, DPH), and a drug-free control group. Seizures were reported in 15 pregnancies; in a subgroup of 9 women without change in drug or schedule, an increase in seizure frequency was evident in 6, a decrease in 1, and no change in 2, regardless of the drug taken. Of 23 children exposed to CBZ in utero, one was born with a lumbar myelomeningocele and multiple congenital anomalies. Of 21 children exposed to DPH, there was one case of severe developmental delay and four with minor features of fetal hydantoin syndromes (FHS). The three groups did not differ in birth weights or gestational ages of the babies. Although much more experience is needed, as a result of this study and other similar reports, Motherisk now offers women treated with CBZ diagnostic tests to detect neural tube defects during the second trimester of pregnancy.
这项前瞻性研究追踪了多伦多病童医院母婴健康项目中癫痫女性的妊娠过程。我们比较了接受卡马西平（CBZ）治疗的女性、接受苯妥英（DPH）治疗的女性以及无药物治疗的对照组的胎儿结局。15次妊娠中有癫痫发作报告；在9名未改变药物或用药方案的女性亚组中，无论服用何种药物，6名女性癫痫发作频率增加，1名减少，2名无变化。在子宫内接触过CBZ的23名儿童中，1名出生时患有腰骶部脊髓脊膜膨出和多种先天性异常。在接触过DPH的21名儿童中，有1例严重发育迟缓，4例有胎儿苯妥英综合征（FHS）的轻微特征。三组婴儿的出生体重和孕周无差异。尽管还需要更多经验，但基于这项研究和其他类似报告，母婴健康项目现在为接受CBZ治疗的女性提供诊断测试，以在妊娠中期检测神经管缺陷。
