多药治疗会增加癫痫女性的不孕风险。

Polytherapy increases the risk of infertility in women with epilepsy.

机构信息

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.

出版信息

Neurology. 2010 Oct 12;75(15):1351-5. doi: 10.1212/WNL.0b013e3181f73673.

DOI:10.1212/WNL.0b013e3181f73673

PMID:20938026

Abstract

BACKGROUND

Reproductive capability is an important concern for women with epilepsy (WWE). We aimed to ascertain the magnitude of infertility in a cohort of WWE who were anticipating pregnancy.

METHODS

A prospective cohort of WWE enrolled in the Kerala Registry of Epilepsy and Pregnancy (1998-2007) in the preconception stage. The endpoint was occurrence of pregnancy. They were divided into those who remained infertile (IG group) and those who had become pregnant during the follow-up period (FG).

RESULTS

Out of 375 women followed up for 1-10 years, 231 had pregnancy and 144 remained infertile (38.4%). Pregnancy occurred within 2 years of follow-up for most patients in the FG group. The IG group had higher mean age, lower education, and longer follow-up when compared to the FG group. Infertility was least (7.1%) for those with no antiepileptic drug (AED) exposure and higher (p = 0.001) with AED exposure (31.8% with 1 AED, 40.7% with 2 AED, and 60.3% with 3 or more AED exposure). Those exposed to phenobarbital had significant risk of infertility, but no such trend was observed with valproate or other drugs. On multiple logistic regression, use of 3 AEDs or more (odds ratio [OR] 17.9; 95% confidence interval [CI] 2.14-149.48), older age (OR 1.32; 95% CI 0.84-2.09), and low education (OR 2.91; 95% CI 1.82-4.65) remained as the important predictors of infertility.

CONCLUSION

More than a third (38.4%) of WWE had infertility. The important predictors of infertility were exposure to multiple AEDs, older age, and lower education.

摘要

背景

生殖能力是癫痫女性（WWE）的一个重要关注点。我们旨在确定预期怀孕的 WWE 队列中不孕的程度。

方法

前瞻性队列研究招募了 1998-2007 年在 preconception 阶段参加喀拉拉邦癫痫与妊娠登记处（Kerala Registry of Epilepsy and Pregnancy）的 WWE。终点是怀孕的发生。他们分为仍然不孕（IG 组）和在随访期间怀孕（FG）的两组。

结果

在随访 1-10 年的 375 名女性中，231 人怀孕，144 人仍然不孕（38.4%）。FG 组的大多数患者在随访的 2 年内怀孕。与 FG 组相比，IG 组的平均年龄更高、教育程度更低、随访时间更长。没有抗癫痫药物（AED）暴露的患者不孕率最低（7.1%），而 AED 暴露的患者不孕率更高（p = 0.001），其中 1 种 AED 暴露的患者不孕率为 31.8%，2 种 AED 暴露的患者不孕率为 40.7%，3 种或更多 AED 暴露的患者不孕率为 60.3%。暴露于苯巴比妥的患者有显著的不孕风险，但丙戊酸钠或其他药物没有这种趋势。在多因素逻辑回归中，使用 3 种或更多 AED（比值比[OR] 17.9；95%置信区间[CI] 2.14-149.48）、年龄较大（OR 1.32；95%CI 0.84-2.09）和教育程度较低（OR 2.91；95%CI 1.82-4.65）仍然是不孕的重要预测因素。