妊娠合并癫痫：一项对照研究的产科和新生儿结局。
Pregnancy with epilepsy: obstetric and neonatal outcome of a controlled study.
机构信息
Department of Genetic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre, Manchester M13 9WL, UK.
出版信息
Seizure. 2010 Mar;19(2):112-9. doi: 10.1016/j.seizure.2009.11.008. Epub 2009 Dec 24.
PURPOSE
To determine the influence of epilepsy and its treatment on pregnancy and its outcome.
DESIGN
Controlled, observational study.
SETTING
National Health Service maternity hospitals in Liverpool and Manchester regions.
POPULATION
277 women with epilepsy (WWE) and 315 control women.
METHODS
WWE were recruited from antenatal clinics. Controls were matched for age and parity but not gestational age. Information was obtained by interview and from clinical records.
MAIN OUTCOME MEASURES
Obstetric complications, mode of delivery, condition of newborn.
RESULTS
Distribution of epilepsy syndromes was similar to previous surveys. Most WWE (67%) received monotherapy with carbamazepine, sodium valproate or lamotrigine. Half WWE had no seizures during pregnancy but 34% had tonic clonic seizures. Seizure-related injuries were infrequent. Pregnancies with obstetric complications were increased in women with treated epilepsy (WWTE 45%, controls 33%; p=0.01). Most had normal vaginal delivery (WWTE 63%, controls 61%; p=0.65). Low birth weight was not increased (WWTE 6.2%, controls 5.2%; p=0.69). There were more major congenital malformations (MCM) (WWTE 6.6%, controls 2.1%; p=0.02) and fetal/infant deaths (WWTE 2.2%, controls 0.3%; p=0.09). Amongst monotherapies MCM prevalence was highest with valproate (11.3%; p=0.005). Lamotrigine (5.4%; p=0.23) and carbamazepine (3.0%; p=0.65) were closer to controls (2.1%). There was no association between MCM and dose of folic acid pre-conception.
CONCLUSION
MCM were more prevalent in the babies of WWTE particularly amongst those receiving sodium valproate.
目的
确定癫痫及其治疗对妊娠及其结局的影响。
设计
对照观察性研究。
地点
利物浦和曼彻斯特地区国民保健制度产科医院。
人群
277 名癫痫妇女（WWE）和 315 名对照妇女。
方法
从产前诊所招募 WWE。对照组按年龄和产次匹配，但不按孕龄匹配。通过访谈和临床记录获取信息。
主要观察指标
产科并发症、分娩方式、新生儿情况。
结果
癫痫综合征的分布与以往调查相似。大多数 WWE（67%）接受卡马西平、丙戊酸钠或拉莫三嗪单一治疗。一半 WWE 妊娠期间无癫痫发作，但 34%有强直阵挛性发作。癫痫相关损伤少见。治疗性癫痫（WWTE）妇女的妊娠合并产科并发症发生率较高（WWTE 45%，对照组 33%；p=0.01）。大多数顺产（WWTE 63%，对照组 61%；p=0.65）。低出生体重无增加（WWTE 6.2%，对照组 5.2%；p=0.69）。严重先天性畸形（MCM）发生率较高（WWTE 6.6%，对照组 2.1%；p=0.02），胎儿/婴儿死亡率也较高（WWTE 2.2%，对照组 0.3%；p=0.09）。单一治疗中，丙戊酸钠的 MCM 发生率最高（11.3%；p=0.005）。拉莫三嗪（5.4%；p=0.23）和卡马西平（3.0%；p=0.65）与对照组（2.1%）更接近。MCM 与孕前叶酸剂量无相关性。
结论
WWTE 所生孩子的 MCM 更为常见，尤其是接受丙戊酸钠治疗的患者。
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