女性癫痫患者的福音到了。最新研究显示,女性癫痫患者在哺乳期间服用治疗药物并不会对孩子将来的智力造成伤害。该研究发表在11月24日出版的美国神经学会的在线医学杂志《神经学》上。
“尽管此项研究还需要扩展到更多孕妇和婴儿身上,但对于那些既想要让自己的孩子享受到母乳喂养的好处,又需要持续服药控制癫痫的妇女来说,目前的这些结果已经可以让她们安心了。”该研究作者、亚特兰大艾默里大学的医学博士兼美国神经学会研究学者Kimford Meador说。
该研究跟踪了194位正在服用癫痫药物的孕妇。她们生下的总共199个婴儿中,42%是母乳喂养。当这些婴孩长到三岁的时候,研究人员对他们进行了智商测试。
研究发现,与非母乳喂养的孩子相比,那些由母乳喂养的孩子的智商并没有什么不同。其中,由母乳喂养的孩子在测试中得到99的分数,而对照组的孩子的得分为98,区别并不大。
这些参加研究的妇女服用的药物包括卡马西平(carbamazepine)、拉莫三嗪(lamotrigine)、苯妥英(phenytoin)和丙戊酸钠(valproate)。Meador表示,还需要对其它的癫痫药物及相关新药的影响结果做进一步的研究。那些服用丙戊酸钠的妇女的孩子总体来说智商测试结果较低,不论他们是否是母乳喂养。美国神经学会的指导手册上明确建议,女性癫痫患者在孕期应避免服用丙戊酸钠,以减少婴儿出生缺陷和认知障碍的风险。指导手册同时建议,女性癫痫患者在孕期应避免一次性摄入一种以上的癫痫药物,因为有研究显示,服用一种以上的癫痫药物会增加婴儿患上出生缺陷的风险。
该文章的编辑作者、布莱根妇女医院和哈佛医学院的Autumn Klein医学博士说,如此大规模地对哺乳期服用癫痫药物的影响进行研究,这几乎是首次。
“因为缺乏对这些药物的副作用的信息,很多妇女得到了不能哺乳的建议,但是母乳喂养对母亲和孩子均有多种积极的情感作用,同时还能降低孩子患心脏病、糖尿病和肥胖症的风险,并帮助母亲预防乳癌和卵巢癌。”Klein说,“这项研究突显出我们当前急需更多癫痫药物在母乳喂养方面的信息及其长期影响。”(生 物 谷Bioon.com)
生 物 谷推荐英文摘要:
Neurology doi: 10.1212/WNL.0b013e3181ffe4a9
Effects of breastfeeding in children of women taking antiepileptic drugs
K.J. Meador, MD, G.A. Baker, PhD, N. Browning, PhD, J. Clayton-Smith, MD, D.T. Combs-Cantrell, MD, M. Cohen, EdD, L.A. Kalayjian, MD, A. Kanner, MD, J.D. Liporace, MD, P.B. Pennell, MD, M. Privitera, MD, D.W. Loring, PhD and For the NEAD Study Group
From Neurology (K.J.M., D.W.L.), Emory University, Atlanta, GA; Walton Centre for Neurology & Neurosurgery (G.A.B.), University of Liverpool, Merseyside, UK; EMMES Corp. (N.B.), Rockville, MD; St. Mary's Hospital (J.C.-S.), Manchester, UK; University of Texas-Southwestern (D.T.C.-C.), Dallas; Neurology (M.C.), Medical College of Georgia, Augusta; University of Southern California (L.A.K.), Los Angeles; Rush University Medical Center (A.K.), Chicago, IL; Neurology (J.D.L.), Riddle Health Care, Media, PA; Neurology (P.B.P.), Brigham & Women's Hospital, Boston, MA; and Neurology (M.P.), University of Cincinnati, Cincinnati, OH.
Background: Breastfeeding is known to have beneficial effects, but there is concern that breastfeeding during antiepileptic drug (AED) therapy may be harmful to cognitive development. Animal and human studies have demonstrated that some AEDs can adversely affect the immature brain. However, no investigation has examined effects of breastfeeding during AED therapy on subsequent cognitive abilities in children.
Methods: The Neurodevelopmental Effects of Antiepileptic Drugs Study is an ongoing prospective multicenter observational investigation of long-term effects of in utero AED exposure on cognition. Between 1999 and 2004, we enrolled pregnant women with epilepsy who were taking a single AED (carbamazepine, lamotrigine, phenytoin, or valproate). We recently reported on differential AED effects on age 3 year cognitive outcomes. In this report, we focus on the effects of breastfeeding during AED therapy on age 3 cognitive outcomes in 199 children.
Results: A total of 42% of children were breastfed. IQs for breastfed children did not differ from nonbreastfed children for all AEDs combined and for each of the 4 individual AED groups. Mean adjusted IQ scores (95% confidence intervals) across all AEDs were breastfed = 99 (96–103) and nonbreastfed = 98 (95–101). Power was 95% to detect a half SD IQ effect in the combined AED analysis, but was inadequate within groups.
Conclusions: This preliminary analysis fails to demonstrate deleterious effects of breastfeeding during AED therapy on cognitive outcomes in children previously exposed in utero. However, caution is advised due to study limitations. Additional research is needed to confirm this observation and extend investigations to other AEDs and polytherapy.