Anticonvulsants in pregnancy.
Med J Aust
; 154(3): 199-202, 1991 Feb 04.
Article
en En
| MEDLINE
| ID: mdl-1988794
ABSTRACT
PIP: The objective of this study was to review the potential problems and their management associated with the use of anticonvulsants in pregnancy. Studies published between 1968-90 assessing the effect of pregnancy on the pharmacokinetics of anticonvulsant drugs, the teratogenicity of anticonvulsants, breastfeeding, and anticonvulsants and the use of oral contraceptives (OCs) in patients taking anticonvulsant medication were reviewed. In general, plasma levels fall during pregnancy and rise during the puerperium. A number of factors including possible reduced absorption, increased volume of distribution, reduced protein binding, increased clearance, and noncompliance all contribute to this fall in plasma concentration. All such drugs are potentially teratogenic. The incidence of fetal malformations is higher in those patients treated with multiple anticonvulsant drugs and on higher dosages with higher plasma levels. Anticonvulsants are excreted i low concentrations in breastmilk. All except valproic acid have been associated with the failure of OCs, this due to liver enzyme induction of these drugs. As plasma levels of anticonvulsants fall during pregnancy, concentrations should be monitored regularly. Due to the fall in protein binding, marginally low total plasma levels of highly protein bound drugs may not reflect reduced unbound levels, and thus an increase in dosage may not be required. In order to reduce teratogenicity, one should aim to use a single anticonvulsant drug and the lowest dosage able to receive seizure control. In general, breastfeeding is not contraindicated.
Palabras clave
Australia; Biology; Breast Feeding; Contraception; Contraceptive Methods; Developed Countries; Drugs--administraction and dosage; Drugs--pharmacodynamics; Family Planning; Health; Human Milk; Infant Nutrition; Lactation; Maternal Physiology; Neurologic Effects; Nutrition; Oceania; Oral Contraceptives; Physiology; Pregnancy; Reproduction; Risk Factors; Treatment
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Complicaciones del Embarazo
/
Epilepsia
/
Anticonvulsivantes
Tipo de estudio:
Etiology_studies
/
Risk_factors_studies
Límite:
Female
/
Humans
/
Newborn
/
Pregnancy
Idioma:
En
Revista:
Med J Aust
Año:
1991
Tipo del documento:
Article
Pais de publicación:
Australia