Markestad T, Ulstein M, Strandjord R E, Aksnes L, Aarskog D
Am J Obstet Gynecol. 1984 Oct 1;150(3):254-8. doi: 10.1016/s0002-9378(84)90361-2.
Serum concentrations of the main vitamin D metabolites and of calcium, phosphate, and alkaline phosphatase were determined in each of the three trimesters of pregnancy and in simultaneously obtained maternal and cord blood at delivery in 22 epileptic women treated with diphenylhydantoin or carbamazepine alone or with a combination with one other drug. The results were compared with similarly obtained data from 22 normal pregnancies. Women in both groups received supplements of 400 IU vitamin D3 per day. All the women had 25-hydroxyvitamin D levels within the normal range for healthy adults (greater than 12 ng/ml) throughout pregnancy. The epileptic women had, however, significantly (p less than 0.05) lower median 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels and higher median 25,26-dihydroxyvitamin D values than the reference group. The 24,25-dihydroxyvitamin D concentrations did not differ significantly, but the median ratio of 24,25-dihydroxyvitamin D to 25-hydroxyvitamin D was higher in the epileptic women at the end of pregnancy (p = 0.05). The respective differences in cord serum concentrations reflected those of the mothers at delivery. Serum calcium tended to be lower during epileptic pregnancy, but none were hypocalcemic. The alkaline phosphatase and phosphate values did not consistently differ from those of the reference women. The median alkaline phosphatase level of cord serum was slightly higher in the epileptic group, but the calcium and phosphate levels were similar to the reference values. The various biochemical parameters of the carbamazepine-treated women tended to be intermediate between those of the healthy and diphenylhydantoin-treated groups. Antiepileptic drug therapy appears to affect vitamin D metabolism and calcium homeostasis during pregnancy. The derangements may not be of major clinical significance, however, in vitamin D-supplemented and normally functioning women on long-term low-dose therapy.
测定了22例单独使用苯妥英或卡马西平或与其他一种药物联合使用进行治疗的癫痫女性在妊娠三个阶段以及分娩时同时采集的母血和脐血中主要维生素D代谢产物以及钙、磷和碱性磷酸酶的血清浓度。将结果与22例正常妊娠的类似数据进行比较。两组女性均每天补充400 IU维生素D3。所有女性在整个孕期的25-羟维生素D水平均在健康成年人的正常范围内（大于12 ng/ml）。然而，癫痫女性的25-羟维生素D和1,25-二羟维生素D的中位数水平显著低于（p<0.05）参照组，而25,26-二羟维生素D的中位数水平则高于参照组。24,25-二羟维生素D浓度无显著差异，但癫痫女性在妊娠末期24,25-二羟维生素D与25-羟维生素D的中位数比值较高（p = 0.05）。脐血血清浓度的相应差异反映了分娩时母亲的差异。癫痫妊娠期间血清钙往往较低，但均无低钙血症。碱性磷酸酶和磷的值与参照女性的值并非始终存在差异。癫痫组脐血血清碱性磷酸酶中位数水平略高，但钙和磷水平与参照值相似。接受卡马西平治疗的女性的各种生化参数往往介于健康组和接受苯妥英治疗组之间。抗癫痫药物治疗似乎会影响孕期维生素D代谢和钙稳态。然而，对于补充了维生素D且长期接受低剂量治疗且功能正常的女性，这些紊乱可能没有重大临床意义。
