抗てんかん薬内服女性の妊娠(<特集>妊娠分娩と脳神経外科疾患)  [in Japanese] Pregnancy in Women treated with Antiepileptic Drugs(<SPECIAL ISSUE>Management of Pregnancy and Delivery in Neurosurgical Patients)  [in Japanese]

抗てんかん薬(AED)服用中の女性から出生した児に認められる奇形頻度は,一般人口の児に比較し有意に高率であり,AEDの投与量が多いほど,また併用薬剤数が多いほど奇形発現率は高まる.妊娠可能年齢にあるてんかん女性の治療にあたっては,妊娠前カウンセリングによって,妊娠中の発作,薬物の催奇形性,てんかんの遺伝性などについて十分な説明を行うべきである.また,妊娠中には,AEDは必要最小限の量をできるだけ単剤で投与すべきであり,胎児モニタリング,AED血中濃度,葉酸の測定が重要となる.本文中に表示した「妊娠可能年齢のてんかん女性の治療ガイドライン」に配慮することにより,服薬てんかん妊婦においても一層安全な妊娠・出産が可能となる.

Women with epilepsy have many legitimate concerns regarding the effect of antiepileptic drugs (AEDs) on their unborn children. These concerns fall into three areas: increased seizure frequency during pregnancy, risk of birth defects, and risks associated with breast-feeding. The incidence of congenital malformations in infants born to mothers taking AEDs is higher than that in healthy women or in women with epilepsy who do not take AEDs during pregnancy. It becomes higher when women with epilepsy taking high dosages of AEDs and many kinds of AEDs. Studies have shown that many of these risks can be minimized with appropriate management and counseling. This article describes some of the data regarding these risks and how best to alter AED therapy to minimize them.