2008, Number 1
Malformations in newborns associated to anticonvulsant consumption during pregnancy. Experience in third level hospital of Mexico
PDF size: 63.78 Kb.
ABSTRACTAim. The purpose of the present study is to determine the relationship between the anticonvulsant drug use during pregnancy and the presence of malformations in the newborns. Methods. The frequency of malformations in the neonates of epileptic mothers under anticonvulsant treatment was analyzed in two periods, one from 1988 to 1992, which included 76 epileptic mothers, and another from 1996 to 2003 with 170 patients. Results: In the first period, 51 (67.1%) of mothers received monotherapy and 25 (32.9%) received polytherapy of phenytoin with carbamazepine, valproic acid or phenobarbital. In this period, 4 newborns (16%) with congenital malformations were registered. In the second period, 159 (93.5%) of the epileptic mothers received monotherapy and 11 (6.5%) received polytherapy of valproic acid with carbamazepine or phenytoin. During this period only 3 newborns 27.3% with malformations were registered. Discussion. Clinical treatment should consider the risk of using polytherapy, mainly if phenytoin or valproic acid are combined with other anticonvulsants.
Laskowska M, Leszczynska B. Pregnancy in women with epilepsy. Gynecol Obstetric Invest 2001; 51: 99-102.
Holmes LB, Harvey EA, Coull BA, et al. The teratogenicity of anticonvulsant drugs. N Engl Med 2001; 344: 1132-8.
Stelmasiak Z, Semezuk W. Analysis of epileptic pregnant woman delivering between 1992-1998 in obstetric department. Neurol Neurochir Pol 2002; 36: 259-66.
Crawford P. Epilepsy and pregnancy. Seizure 2002; 11(Suppl. A): 212-9.
Leppik IE. Treatment of epilepsy in 3 specialized populations. Am J Manag Care 2001; 7: S221-S226.
Yerby MS. Management issues for women with epilepsy: neural tube and folic acid supplementation. Neurology 2003; 61(Suppl. 2): 23-6.
Yerby MS. The use of anticonvulsants during pregnancy. Semin Perinatol 2001; 25: 153-8.
Palmieri C, Canger R. Teratogenic potential of the newer antiepileptic drugs: what is known and how should this influence prescribing?. CNS Drugs 2002; 16: 755-64.
Campistol J. Teratogenic effects of epilepsy and antiepileptic drugs. Rev Neurol 2002; 35(Suppl. 1): S135-S143.
Kaplan PW. Reproductive health effects and teratogenicity of antiepileptic drugs. Neurology 2004; 63(Suppl. 4): 13-23.
Kaaja E, Kaaja R, Hiilesmaa V. Major malformations in offspring of women with epilepsy. Neurology 2003; 60: 575-9.
Pennell PB. Antiepileptic drug pharmacokinetics during pregnancy and lactation. Neurology 2003a; 61(Suppl. 2): 35-42.
Pennell PB. The importance of monotherapy in pregnancy. Neurology 2003b; 61(Suppl. 4): 31-8.
Laskowska M, Leszczynska-Gorzelak B, Oleszczuk J. Evaluation of antiepileptic therapy during pregnancy. Ginekol Pol 2002; 73: 35-42.
Nelson W, Behrman R, Kliegman R. Tratado de Pediatría. 17th. Ed. Editorial Elsevier; 2004.
Kasper D. Harrison’s Principles of internal medicine. 16th. Ed. New York: McGraw-Hill; 2004.
Stedman Bilingüe. Diccionario de Ciencias. Médica Panamericana, 2001.
Centers for diseases control and prevention. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR 1992; 41: 1-7.
Clarck Nac, Fisk NM. Compliance with the Department of Health recommendations: routine folate prophylaxis to prevent fetal neural tube defects. Br J Obstet Gynaecol 1994; 101: 709-10.
Stoler JM. Maternal antiepileptic drugs use and effects on fetal development. Curr Opin Pediatr 2001; 13: 566-71.
Oguni M, Osawa M. Epilepsy and pregnancy. Epilepsia 2004; 45(Suppl. 8): 37-41.
Sander JW. The use of antiepileptic drugs-principles and practice. Epilepsia 2004; 45(Suppl. 6): 28-34.
Jones KL, Lacro RV, Johnson KA, Adams J. Pattern of malformations in the children of women treated with carbamazepine during pregnancy. N Engl J Med 1989; 320: 1661-6.
Rosa FW. Spina bifida in infants of women treated with carbamazepine during pregnancy. N Engl J Med 1991; 324: 674-7.
Omtzigt J. Prenatal diagnosis of spina bifida aperta after firsttrimester valproate exposure. Prenat Diagn 1992; 12: 893-7.
Diav-Citrin O, Shechtman S, Amon J, Omoy A. Is carbamazepine teratogenic? a prospective controlled study of 210 pregnancies. Neurology 2001; 57: 321-4.
Yonkers KA, Winsner KL, Stowe Z, et al. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry 2004; 161: 608-20.