Menzler K, Fuest S, Immisch I, Knake S
Epilepsiezentrum Hessen am Universitätsklinikum Gießen und Marburg, Standort Marburg, Klinik für Neurologie, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Deutschland.
Nervenarzt. 2016 Sep;87(9):937-42. doi: 10.1007/s00115-016-0176-z.
On average, female patients with epilepsy have 0.9 children, which is below the birth rate of healthy women. One reason is insufficient counselling.
To summarize the current data relevant to counselling pregnant women with epilepsy.
Discussion of research and recommendations concerning seizure control during pregnancy, pregnancy and birth complications, congenital malformations, and breastfeeding.
Changes in seizure frequency during pregnancy are variable and partly due to changes in the serum concentrations of antiepileptic drugs. Epilepsy patients have a slightly higher risk for some pregnancy and birth complications including spontaneous abortion, pre- and postpartum bleeding, induction of labour, and caesarean section. In particular, the administration of valproic acid can lead to congenital malformations and a lower IQ of the child. Folic acid seems to have a protective effect. Data concerning breastfeeding are insufficient.
If possible, epilepsy patients should be treated with a low-dose monotherapy during pregnancy and valproic acid should be avoided. Treatment with lamotrigine requires frequent control of serum concentration. Supplementary folic acid (5 mg daily dose) is recommended. Epilepsy is not an indication for a caesarean section.
癫痫女性患者平均生育0.9个孩子，低于健康女性的出生率。原因之一是咨询不足。
总结与癫痫孕妇咨询相关的现有数据。
讨论关于孕期癫痫发作控制、妊娠及分娩并发症、先天性畸形和母乳喂养的研究及建议。
孕期癫痫发作频率变化不定，部分原因是抗癫痫药物血清浓度的改变。癫痫患者发生某些妊娠及分娩并发症的风险略高，包括自然流产、产前和产后出血、引产和剖宫产。特别是，丙戊酸的使用可导致先天性畸形及儿童智商降低。叶酸似乎具有保护作用。关于母乳喂养的数据不足。
若有可能，癫痫患者在孕期应采用低剂量单药治疗，应避免使用丙戊酸。使用拉莫三嗪治疗时需频繁监测血清浓度。建议补充叶酸（每日剂量5毫克）。癫痫并非剖宫产的指征。
