抗癫痫药物治疗的妊娠中非药物因素对胎儿畸形的影响。
The contribution of non-drug factors to fetal malformation in anti-seizure-medication-treated pregnancy.
机构信息
Department of Medicine and Neurosciences, Royal Melbourne Hospital and University of Melbourne, Parkville, Victoria 3050, Australia; Department of Neuroscience, Alfred Health, and Monash University, Melbourne, Vic 3004, Australia.
Department of Neuroscience, Alfred Health, and Monash University, Melbourne, Vic 3004, Australia.
出版信息
Epilepsy Behav. 2021 May;118:107941. doi: 10.1016/j.yebeh.2021.107941. Epub 2021 Apr 11.
PURPOSE
To assess the possible contribution of factors in additional to intrauterine anti-seizure medication (ASM) exposure in the occurrence of fetal malformation in women with ASM-treated epilepsy.
RESULTS
Logistic regression analysis showed that maternal age over 31 years, family histories of fetal malformation, and conception after assisted fertility treatment, and also dosage of valproate, carbamazepine, and topiramate, made statistically significant (P<0.05) contributions to the fetal malformation rate in 2223 pregnancies in Australian women with epilepsy. The malformation rates were lower in pregnancies where the non-ASM-associated contributory factors were not present: statistically significantly so for all ASM-exposed pregnancies, and those pregnancies exposed to the more potent teratogenic drugs.
CONCLUSION
It is important to consider the possible roles of identified, and also possible non-identified, non-ASM factors in relation to the occurrence of fetal malformations in the pregnancies of women with ASM-treated epilepsy.
目的
评估除宫内抗癫痫药物（ASM）暴露以外的其他因素对接受 ASM 治疗的癫痫女性胎儿畸形发生的可能贡献。
结果
Logistic 回归分析显示，母亲年龄超过 31 岁、胎儿畸形家族史、辅助生育治疗后的受孕，以及丙戊酸、卡马西平、托吡酯的剂量，对澳大利亚癫痫女性 2223 例妊娠中的胎儿畸形发生率有统计学意义（P<0.05）。在不存在非 ASM 相关促成因素的妊娠中，畸形发生率较低：所有接受 ASM 暴露的妊娠以及那些暴露于更具致畸性药物的妊娠中，差异均有统计学意义。
结论
在接受 ASM 治疗的癫痫女性的妊娠中，考虑到已确定的、也可能是未确定的非 ASM 因素与胎儿畸形发生的可能作用很重要。
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