Practice Parameter update: Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): Teratogenesis and perinatal outcomes Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society

被引：245

作者：

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

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

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

Hauser, W. A. ^{[3
]}

Gronseth, G. S. ^{[4
]}

French, J. A. ^{[5
]}

Wiebe, S. ^{[6
]}

Thurman, D. ^{[7
]}

Koppel, B. S. ^{[8
]}

Kaplan, P. W. ^{[9
]}

Robinson, J. N. ^{[10
]}

Hopp, J. ^{[11
]}

Ting, T. Y. ^{[11
]}

Gidal, B. ^{[12
]}

Hovinga, C. A. ^{[13
]}

Wilner, A. N.

Vazquez, B.

Holmes, L. ^{[10
]}

Krumholz, A. ^{[11
]}

Finnell, R. ^{[14
]}

Hirtz, D. ^{[15
]}

Le Guen, C. ^{[16
]}

机构：

[1] Univ Miami, Miami, FL USA

[2] Emory Univ, Atlanta, GA 30322 USA

[3] Columbia Univ, New York, NY USA

[4] Univ Kansas, Med Ctr, Kansas City, KS 66103 USA

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

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

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

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

[9] Johns Hopkins Univ, Baltimore, MD USA

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

[11] Univ Maryland, Baltimore, MD 21201 USA

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

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

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

[15] NINDS, Bethesda, MD 20892 USA

[16] Univ Penn, Philadelphia, PA 19104 USA

来源：

NEUROLOGY | 2009年 / 73卷 / 02期

关键词：

ANTIEPILEPTIC DRUGS; IN-UTERO; CONGENITAL-MALFORMATIONS; PSYCHOMOTOR DEVELOPMENT; MATERNAL EPILEPSY; PRENATAL EXPOSURE; CHILDREN; INTELLIGENCE; VALPROATE; ANTICONVULSANTS;

D O I：

10.1212/WNL.0b013e3181a6b312

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. Methods: Systematic review of relevant articles published between January 1985 and June 2007. Results: It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine and possible compared to phenytoin or lamotrigine. Compared to untreated WWE, it is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. It is probable that antiepileptic drug (AED) polytherapy as compared to monotherapy regimens contributes to the development of MCMs and to reduced cognitive outcomes. For monotherapy, intrauterine exposure to VPA probably reduces cognitive outcomes. Further, monotherapy exposure to phenytoin or phenobarbital possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of <7. Recommendations: If possible, avoidance of valproate (VPA) and antiepileptic drug (AED) polytherapy during the first trimester of pregnancy should be considered to decrease the risk of major congenital malformations (Level B). If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered to prevent reduced cognitive outcomes (Level B). If possible, avoidance of phenytoin and phenobarbital during pregnancy may be considered to prevent reduced cognitive outcomes (Level C). Pregnancy risk stratification should reflect that the offspring of women with epilepsy taking AEDs are probably at increased risk for being small for gestational age (Level B) and possibly at increased risk of 1-minute Apgar scores of <7 (Level C). Neurology(R) 2009; 73: 133-141

引用

页码：133 / 141

页数：9

共 41 条

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