Koren Gideon, Nava-Ocampo Alejandro A, Moretti Myla E, Sussman Reuven, Nulman Irena
Motherisk Team, Hospital for Sick Children, Toronto.
Can Fam Physician. 2006 Apr;52(4):441-2, 444, 447.
Increasing numbers of pregnant patients are treated with valproic acid, not just for epilepsy, but also for psychiatric conditions. Are there teratogenic risks other than the risk of spina bifida?
It has now become evident that valproic acid might cause more than just neural tube defects (NTDs). In a systematic review of all cohort studies intended to answer this question, higher rates of major malformations (and not just NTDs) were found in most studies. The calculated relative risk was 2.59 when compared with other antiepileptic drugs and was 3.77 when compared with risk in the general population. There is compelling evidence that the risk is dose dependent. The risks appear to begin increasing at doses of 600 mg/d and to become more prominent at doses above 1000 mg/d.
越来越多的孕妇使用丙戊酸进行治疗，不仅用于癫痫，还用于精神疾病。除了脊柱裂风险外，是否存在其他致畸风险？
现在已经很明显，丙戊酸可能造成的影响不止神经管缺陷（NTDs）。在一项旨在回答这个问题的所有队列研究的系统评价中，大多数研究发现严重畸形（而不仅仅是NTDs）的发生率更高。与其他抗癫痫药物相比，计算得出的相对风险为2.59，与普通人群的风险相比为3.77。有令人信服的证据表明，这种风险是剂量依赖性的。风险似乎在每日剂量600毫克时开始增加，在剂量高于1000毫克时变得更加显著。
