概括
对于生育期患者 (PWECP),本指南建议使用特定的抗发作药物 (ASM) 和叶酸来改善怀孕和神经发育结果. 由于存在重大先天性形和发育问题的风险,应避免使用瓦尔酸.
科学领域:
- 神经学 神经学
- 产科 产科 产科 产科 产科
- 儿科 儿科 儿科
背景情况:
- 会影响生育年龄的妇女 (PWECP),需要在怀孕期间仔细管理抗发作药物 (ASM).
- ASM可能会影响胎儿发育,导致重大先天性形 (MCM) 和神经发育问题.
- 叶酸补充对于减轻与ASM相关的风险至关重要.
研究的目的:
- 在PWECP中为ASM和叶酸提供最新的基于证据的建议.
- 引导临床医生优化控制和胎儿结果.
- 为了最大限度地减少患有的母亲生育的儿童的周产期和神经发育不良后果.
主要方法:
- 在2022年8月之前对ASM,叶酸和怀孕结果的研究进行系统审查.
- 由一个多学科小组制定实践建议.
- 整合证据,关心原则和结构化推理的推理.
主要成果:
- 临床医生应推ASM和剂量,以平衡发作控制和胎儿安全在怀孕前.
- 在PWECP中应避免使用烯酸,因为MCM,神经管缺陷 (NTD) 和神经发育问题的高风险.
- 拉莫特里金, levetiracetam,或oxcarbazepine是首选的ASMs,以最大限度地降低MCM风险.
- 叶酸 (≥0.4 mg/天) 建议在孕前和怀孕期间在ASM上使用PWECP,以减少NTD风险.
结论:
- 优化ASM选择和叶酸补充对于PWECP至关重要.
- 在怀孕期间最大限度地减少发作对于母亲和胎儿的安全至关重要.
- 避免使用酸,并考虑使用拉莫特里金或 levetiracetam 等替代品,可以显著减少不良怀孕和发育结果.
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