孕前癫痫控制情况对孕期癫痫发作以及母婴结局的预测分析  

The efficacy of seizure control prior to pregnancy in predicting seizures during pregnancy and pregnancy outcomes

作　　者：韩烨楠 毓青[1] 任梦若 庞杰 杨卫东[3] 陈英[1] 吕慧[1] 姚晓娟[1] 陈旨娟[3] HAN Yenan;YU Qing;REN Mengruo;PANG Jie;YANG Weidong;CHEN Ying;LV Hui;YAO Xiaojuan;CHEN Zhijuan(Department of Neurology,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Neurology,Zhengzhou Central Hospital,Zhengzhou 450000,China;Department of Neurosurgery,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院神经内科,天津300052 [2]河南省郑州市中心医院神经内科,郑州450000 [3]天津医科大学总医院神经外科,天津300052

出　　处：《癫痫杂志》2021年第1期12-20,共9页Journal of Epilepsy

摘　　要：目的探讨孕前6个月和孕前1年癫痫控制情况能否预测孕期癫痫发作风险以及母婴不良结局的发生,以指导女性癫痫患者(Women with epilepsy,WWE)最佳生育时机的选择。方法回顾性分析2016年8月—2020年1月期间在天津医科大学总医院癫痫门诊随诊的WWE 46例,共48次妊娠,分析妊娠期癫痫发作的危险因素,根据患者孕期无发作的时间分组,分析各组在妊娠期的癫痫发作情况、妊娠期并发症以及妊娠结局的差异。结果①48次妊娠中,妊娠期有癫痫发作者较无发作者出现胎膜早破的风险显著升高(34.6%vs.0.0%),差异具有统计学意义(P<0.01);妊娠期高血压(Pregnancy-induced hypertension,PIH)、妊娠期糖尿病(Gestational diabetes mellitus,GDM)、妊娠期贫血以及总妊娠期并发症发生率无统计学差异(P>0.05);子代平均出生体重略低,低出生体重、胎儿宫内窘迫发生率较高,但差异无统计学意义(P>0.05);②孕前6个月有癫痫发作与孕期癫痫发作显著相关[RR=4.28,95%CI(2.10,8.74),P<0.01];与孕前6个月无发作组对比,总不良妊娠结局发生率升高,差异有统计学意义[RR=2.00,95%CI(1.10,3.65),P<0.05];③孕前6个月无发作组与孕前≥1年无发作组妊娠期癫痫发作率分别为25.0%和20.0%,差异无统计学意义(P>0.05);相比孕前6个月无发作组,孕前≥1年无发作组发生PIH、妊娠期贫血的风险较低,后代发生低出生体重、早产、胎儿宫内窘迫的风险较低,但差异无统计学意义(P>0.05)。结论保证至少孕前6个月无发作将显著降低孕期癫痫发作的概率,且与较低的不良妊娠结局发生率显著相关。建议育龄期的女性癫痫患者在达到至少6个月癫痫无发作后再计划妊娠。Objective To explore the predictors of seizures during pregnancy,and to explore whether seizure control in the 6 months and 1 year prior to pregnancy can predict the risk of seizures during pregnancy and the occurrence of adverse maternal and infant outcomes,so as to guide the choice of the best fertility timing for women with epilepsy(WWE).Methods A total of 46 WWE with 48 pregnancies were enrolled in Epilepsy Clinics of Tianjin Medical University from August 2016 to January 2020.Retrospective analysis was used to analyze the risk factors of epileptic seizures in pregnancy.The patients were grouped according to the time of absence of seizures during pregnancy.To analyze the influence of epileptic seizure,pregnancy complications and pregnancy outcome.Results①Among 48 pregnancies,the risk of premature rupture of membranes was significantly higher in patients with epilepsy than those without epilepsy(34.6%vs.0.0%),and the difference was statistically significant(P<0.01).There was no significant difference in the risk of PIH,GDM,gestational anemia and pregnancy complications(P>0.05).For women who had seizure during pregnancy,the mean birth weight of the offspring was slightly lower,and the incidence of low birth weight and fetal distress was higher,but the difference was not statistically significant(P>0.05);②Seizures in the 6 months before pregnancy were significantly associated with seizures during pregnancy[RR=4.28,95%CI(2.10,8.74),P<0.01].Further,the risk of adverse pregnancy outcomes increased significantly[RR=2.00,95%CI(1.10,3.65),P<0.05]for WWE who had seizure in 6 month before pregnancy;③The rates of seizures during pregnancy in the two groups were 25.0%and 20.0%,but the difference was not statistically significant(P>0.05).Compared with the 6-months,the≥1 year group had a lower risk of PIH and gestational anemia,and the offspring had a lower risk of low birth weight,premature delivery and fetal distress,but the difference was not statistically significant(P>0.05).Conclusion Ensuring seizure-free at l

关 键 词：癫痫 妊娠 癫痫控制 孕前咨询 预后因素 

分 类 号：R742.1[医药卫生—神经病学与精神病学]