D'Souza S W, Robertson I G, Donnai D, Mawer G
St Mary's Hospital, Manchester.
Arch Dis Child. 1991 Mar;66(3):320-4. doi: 10.1136/adc.66.3.320.
In a prospective study infants born to mothers with epilepsy (n = 61) were found to have an unexpectedly high incidence of congenital anomalies (26/61, 43%) and neonatal conditions (26/61, 43%) compared with controls (0/62, and 6/62, 10%, respectively). There were two neonatal deaths in the study group but none among the controls. Hypoplasia of the finger or toenails was a common congenital anomaly in those infants whose mothers had received phenytoin alone or in combination with other anticonvulsant drugs (11 of 40, 28%). The mean serum phenytoin concentration was higher among mothers of infants with hypoplastic nails than among those with normal nails. Jitteriness was a common neonatal condition affecting infants of epileptic mothers (11 of 61, 18%) but not controls The mean cord serum phenytoin concentrations were similar among jittery and non-jittery infants. At follow up (after excluding one infant with Down's syndrome from the study group) the infants seemed to have developed normally, though one had serious learning difficulties at school. We suggest that hypoplasia of the nails is related to high maternal serum concentrations of phenytoin, and though 18% of infants born to epileptic mothers were jittery compared with no control infants this may not be the result of withdrawal of the drug in all cases.
在一项前瞻性研究中，发现癫痫母亲所生婴儿（n = 61）的先天性异常（26/61，43%）和新生儿疾病（26/61，43%）的发生率意外高于对照组（分别为0/62和6/62，10%）。研究组有2例新生儿死亡，而对照组无死亡病例。手指或脚趾甲发育不全是母亲单独使用苯妥英或与其他抗惊厥药物联合使用的婴儿中常见的先天性异常（40例中有11例，28%）。指甲发育不全婴儿的母亲血清苯妥英平均浓度高于指甲正常婴儿的母亲。易激惹是影响癫痫母亲所生婴儿的常见新生儿疾病（61例中有11例，18%），但对照组未出现。易激惹和不易激惹婴儿的脐带血清苯妥英平均浓度相似。随访时（研究组排除1例唐氏综合征婴儿后），婴儿似乎发育正常，尽管有1例在学校存在严重学习困难。我们认为指甲发育不全与母亲血清中高浓度的苯妥英有关，并且尽管癫痫母亲所生婴儿中有18%易激惹，而对照组婴儿无此情况，但这并非在所有病例中都是药物戒断的结果。
