孕期三种抗癫痫药暴露后分娩鼻骨缺失新生儿的临床分析

Clinical analysis of giving birth to infant with nasal bone loss after exposure to three antiepileptic drugs during pregnancy

目的探讨母体孕期暴露三种抗癫痫药后分娩鼻骨缺失新生儿的相关因素及药物遗传效应。方法通过对1例孕期同时暴露托吡酯、奥卡西平和拉莫三嗪至足月分娩致新生儿鼻骨缺失的案例报道,并综合文献分析鼻骨缺失新生儿与抗癫痫药物使用的相关性及其致畸分子机制。结果与结论孕期给予非典型抗癫痫药的三药联合治疗后分娩鼻骨缺失新生儿,提示包括托吡酯在内的抗癫痫药物联合可能显著增加胎儿口面部畸形风险。临床药师应协助临床更好地保障母胎用药安全有效,提高女性癫痫患者优生优育水平。

Objective To investigate the correlation between neonatal nasal-bone loss and prenatal exposure to multiple antiepileptic drugs,as well as the genetic effects of drugs.Methods This paper reports a case of neonatal nasal bone deficiency caused by simultaneous exposure to topiramate,oxcarbazepine and lamotrigine during pregnancy to term delivery,and analyzes the correlation between nasal bone deficiency and the use of antiepileptic drugs as well as the teratogenic molecular mechanism.Results and Conclusion Our study focused on nasalbone teratogenicity of anti-epileptic agents,and found that epileptic patients who are experiencing pregnancy may be suggested to be restricted to anti-epileptic drugs because taking antiepileptic drugs during pregnancy,the possibility of newborns suffered from nasal-bone loss may be significantly increased.Clinical pharmacists should assist the clinic to better ensure the safety and effectiveness of maternal-fetal medication,and improve the prenatal and postnatal care of female epilepsy patients.