ABSTRACT
BACKGROUND: Minor facial anomalies in 14-33% of exposed fetuses have been associated with the teratogenic effect of antiepileptic drugs (AED) since 1968. The purpose of this article is to describe the facial characteristics of offspring of epileptic mothers with and without exposure to AED by means of 22 anthropometric measurements, for the purpose of comparison with the measurements of offspring of non-epileptic women previously described in the literature, and to correlate the facial anomalies with the specific drug. METHODS: An interval was defined where 95% of the central values were considered as "common values" and the remaining 5% as "uncommon values" (UV) or as being in the "alert zone"; the odds ratio with Wolf modification was used and then Fisher's test for comparison with healthy newborns. Full-term eutrophic newborns of epileptic mothers who received attention at the epilepsy clinic of a gyneco-obstetric center were included. RESULTS: During the study period, 72 eutrophic, full-term newborns were included; in 70 cases at least one measurement was found in the alert zone, with a predominance of the mid-line area. No differences were found between neonates who received monotherapy vs. polytherapy. The groups exposed to phenobarbital, clonazepam and multiple AED showed more uncommon values (p < 0.05), identified as minor dysmorphisms by other authors. It seems to be a particular susceptibility of the mid-line of the face to show the effects of AED and, additionally, of environmental agents. CONCLUSIONS: No differences were found in the facial values among the different AED used in monotherapy form. It is suggested that the choice of drug used during pregnancy must be decided on according to the clinical diagnosis of each mother's epilepsy, and not on the basis of potential teratogenic risk.
Subject(s)
Abnormalities, Drug-Induced/diagnosis , Epilepsy/pathology , Face/abnormalities , Mothers , Anthropometry , Case-Control Studies , Epilepsy/drug therapy , Female , Humans , Infant, Newborn , PregnancyABSTRACT
During pregnancy, there are several physiological changes that influence the kinetics of medication administrated during this time. These physiological changes are not reestablished immediately during delivery; so, its concentration in biologic fluids is different when is administered immediately after delivery, than several weeks after. The purpose in this work was to identify the changes of pharmacocinetics constants for fenitoin and carbamacepine, in epileptic patients. When the same dose is maintained, during different times of postpartum. In 20 Mexican epileptic women, the plasma and milk concentrations of fenitoina during 60 day postpartum and in 14 carbamacepine was determined. In all the patients pharmakocinetics of anticonvulsivant, in each study period (5, 15, 30, 45 y 60 days postpartum). Excretion index of maternal milk was determined. Maximal plasmatic concentration of fentoine had no variation; however, carbamacepine was higher during the late period. There were no differences in the areas under curve and life all the middle of elimination and in excretion index.
Subject(s)
Anticonvulsants/pharmacokinetics , Carbamazepine/pharmacokinetics , Epilepsy/drug therapy , Phenytoin/pharmacokinetics , Postpartum Period , Pregnancy Complications/drug therapy , Animals , Cricetinae , Female , Humans , Milk, Human/chemistry , PregnancyABSTRACT
Durante el embarazo existen una serie de cambios fisiológicos que influyen en la cinética de los medicamentos administrativos durante esta etapa: Estos cambios fisiológicos no se restauran inmediatamente en el parto, de tal manera que su concentración en los fluidos biológicos es diferente cuando se administra inmediatamente después del parto que varias semanas posterior al mismo. El presente trabajo tiene como propósito identificar los cambios en las constantes farmacocinéticas de fenitoína y carbamacepina, en pacientes epilépticas cuando se mantiene una misma dosis durante diferentes etapas del postparto. En 20 mujeres mexicanas epilépticas se determinó la concentración en plasma y leche de fenitoína durante 60 días postparto y en 14 se determinó carbamacepina. A todas las pacientes se les realizó la farmacocinética de los anticonvulsivantes en cada periodo de estudio (5, 15, 30, 45 y 60 días posparto) y se determinó el índice de excreción en leche materna. Las concentraciones plasmáticas de fenitoína no presentaron variaciones, sin embargo la carbanacepina fue más alta en el periodo tardió, también se observaron diferencias en las áreas bajo la curva y vida media de eliminación y en los índices de excreción
Subject(s)
Humans , Female , Carbamazepine/pharmacokinetics , Epilepsy/drug therapy , Phenytoin/pharmacokinetics , Lactation/drug effects , Milk, Human/drug effects , Postpartum Period/drug effectsABSTRACT
The association between epilepsy and pregnancy trace a problem for possible complications for the mother and the foetus by toxicity of antiepileptic drugs (AED) on the epilepsy itself. A group of 100 pregnant epileptic women were prospectively studied (clinically and by measurement of serum levels (SL) of AED. Mothers participating lived in the Valley of Mexico, 61 patients received monotherapy and 18 received no drugs. The most commonly used were phenytoin (41), carbamazepine (35) and valproate. The SL of AED were into or under the range recommended for seizures control, only 10 patients have increased their seizures (sleepless and AED medication were common causes). Obstetric complications in our patients do not differ from healthy pregnant women. The 50% of deliveries were resolved by cesarean section (only by neurologic recommendation). No major malformations were observed and the 12% showed minor dysmorphic features. This work show the Obstetric and Neurologic follow-up of 100 mexican women with epilepsy during pregnancy, treated in a third level attention hospital, their complications, pharmacologic recommendations and risk of teratogenicity.
