Meador K J, Pennell P B, Harden C L, Gordon J C, Tomson T, Kaplan P W, Holmes G L, French J A, Hauser W A, Wells P G, Cramer J A
Department of Neurology, Emory University, Atlanta, GA 30322, USA.
Neurology. 2008 Sep 30;71(14):1109-17. doi: 10.1212/01.wnl.0000316199.92256.af. Epub 2008 Aug 13.
Most pregnant women with epilepsy require antiepileptic drug (AED) therapy. Present guidelines recommend optimizing treatment prior to conception, choosing the most effective AED for seizure type and syndrome, using monotherapy and lowest effective dose, and supplementing with folate. The Epilepsy Therapy Project established the international Health Outcomes in Pregnancy and Epilepsy (HOPE) forum to learn more about the impact of AEDs on the developing fetus, particularly the role of pregnancy registries in studying AED teratogenicity. The primary outcome of interest in these registries is the occurrence of major congenital malformations, with some data collected on minor malformations. Cognitive and behavioral outcomes are often beyond the timeframe for follow-up of these registries and require independent study. The HOPE consensus report describes the current state of knowledge and the limitations to interpretations of information from the various sources. Data regarding specific risks for both older and newer AEDs need to be analyzed carefully, considering study designs and confounding factors. There is a critical need for investigations to delineate the underlying mechanisms and explain the variance seen in outcomes across AEDs and within a single AED.
大多数癫痫孕妇需要抗癫痫药物（AED）治疗。目前的指南建议在受孕前优化治疗，根据癫痫发作类型和综合征选择最有效的AED，采用单药治疗并使用最低有效剂量，同时补充叶酸。癫痫治疗项目设立了国际妊娠与癫痫健康结局（HOPE）论坛，以进一步了解AED对发育中胎儿的影响，特别是妊娠登记在研究AED致畸性方面的作用。这些登记中感兴趣的主要结局是重大先天性畸形的发生情况，还收集了一些关于轻微畸形的数据。认知和行为结局通常超出了这些登记的随访时间范围，需要进行独立研究。HOPE共识报告描述了当前的知识状态以及对来自各种来源信息进行解读的局限性。需要仔细分析有关新旧AED特定风险的数据，同时考虑研究设计和混杂因素。迫切需要进行调查以阐明潜在机制，并解释不同AED之间以及单一AED内结局出现差异的原因。
