Practice Parameter update: Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): Vitamin K, folic acid, blood levels, and breastfeeding Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society

被引：134

作者：

Harden, C. L. ^{[1
]}

Pennell, P. B. ^{[2
]}

Koppel, B. S. ^{[3
]}

Hovinga, C. A. ^{[4
]}

Gidal, B. ^{[5
]}

Meador, K. J. ^{[2
]}

Hopp, J. ^{[6
]}

Ting, T. Y. ^{[6
]}

Hauser, W. A.

Thurman, D. ^{[7
]}

Kaplan, P. W. ^{[8
]}

Robinson, J. N. ^{[9
]}

French, J. A. ^{[10
]}

Wiebe, S. ^{[11
]}

Wilner, A. N.

Vazquez, B.

Holmes, L. ^{[9
]}

Krumholz, A. ^{[6
]}

Finnell, R. ^{[12
]}

Shafer, P. O. ^{[13
]}

Le Guen, C. ^{[14
]}

机构：

[1] Univ Miami, Miami, FL USA

[2] Emory Univ, Atlanta, GA 30322 USA

[3] New York Med Coll, New York, NY USA

[4] Univ Tennessee, Hlth Sci Ctr, Memphis, TN USA

[5] Univ Wisconsin, Sch Pharm, Madison, WI 53706 USA

[6] Univ Maryland, Baltimore, MD 21201 USA

[7] Ctr Dis Control & Prevent, Atlanta, GA USA

[8] Johns Hopkins Univ, Baltimore, MD USA

[9] Harvard Univ, Sch Med, Boston, MA USA

[10] NYU, Sch Med, New York, NY USA

[11] Univ Calgary, Calgary, AB T2N 1N4, Canada

[12] Texas A&M Univ, Hlth Sci Ctr, Houston, TX USA

[13] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[14] Univ Penn, Philadelphia, PA 19104 USA

来源：

NEUROLOGY | 2009年 / 73卷 / 02期

关键词：

ANTIEPILEPTIC DRUGS; PLACENTAL-TRANSFER; NURSED INFANTS; PROTEIN-BINDING; VALPROIC ACID; PLASMA-CONCENTRATIONS; MAJOR MALFORMATIONS; FETAL ACCUMULATION; LACTATION PERIOD; NEONATAL-PERIOD;

D O I：

10.1212/WNL.0b013e3181a6b325

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Objective: To reassess the evidence for management issues related to the care of women with epilepsy (WWE) during pregnancy, including preconceptional folic acid use, prenatal vitamin K use, risk of hemorrhagic disease of the newborn, clinical implications of placental and breast milk transfer of antiepileptic drugs (AEDs), risks of breastfeeding, and change in AED levels during pregnancy. Methods: A 20-member committee evaluated the available evidence based on a structured literature review and classification of relevant articles published between 1985 and October 2007. Results: Preconceptional folic acid supplementation is possibly effective in preventing major congenital malformations in the newborns of WWE taking AEDs. There is inadequate evidence to determine if the newborns of WWE taking AEDs have a substantially increased risk of hemorrhagic complications. Primidone and levetiracetam probably transfer into breast milk in amounts that may be clinically important. Valproate, phenobarbital, phenytoin, and carbamazepine probably are not transferred into breast milk in clinically important amounts. Pregnancy probably causes an increase in the clearance and a decrease in the concentration of lamotrigine, phenytoin, and to a lesser extent carbamazepine, and possibly decreases the level of levetiracetam and the active oxcarbazepine metabolite, the monohydroxy derivative. Recommendations: Supplementing women with epilepsy with at least 0.4 mg of folic acid before they become pregnant may be considered (Level C). Monitoring of lamotrigine, carbamazepine, and phenytoin levels during pregnancy should be considered (Level B) and monitoring of levetiracetam and oxcarbazepine (as monohydroxy derivative) levels may be considered (Level C). A paucity of evidence limited the strength of many recommendations. Neurology(R) 2009; 73: 142-149

引用

页码：142 / 149

页数：8

共 40 条

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[12] Levetiracetam concentrations in serum and in breast milk at birth and during lactation [J].