PDF(Pubmed)
Abstract：
Data on the ability of anticonvulsants and lithium to enter fetal and newborn circulation has become increasingly available; here we estimated penetration ratios in a series of matrices from combined samples of pregnant/breastfeeding women treated with anticonvulsants or lithium.
We conducted a systematic literature search in PubMed/EMBASE for studies with concentrations of anticonvulsants/lithium from maternal blood, amniotic fluid, umbilical cord blood and/or breast milk. Penetration ratios were calculated by dividing the concentrations in amniotic fluid, umbilical cord plasma or breast milk by the maternal concentrations. When data from multiple studies were available, we calculated combined penetration ratios, weighting studies\' mean by study size.
Ninety-one eligible studies for brivaracetam, carbamazepine, clonazepam, ethosuximide, gabapentin, lacosamide, lamotrigine, levetiracetam, lithium, oxcarbazepine, perampanel, phenobarbital, phenytoin, pregabalin, primidone, topiramate, valproate, vigabatrin and zonisamide were identified. For amniotic fluid, the highest penetration ratios were estimated for levetiracetam (mean 3.56, range 1.27-5.85, n = 2) and lowest for valproate (mean 0.11, range 0.02-1.02, n = 57). For umbilical cord plasma, oxcarbazepine had the highest ratio (mean 1.59, range 0.11-4.33, n = 12) with clonazepam having the lowest (mean 0.55, range 0.52-0.59, n = 2). For breast milk, the highest ratios were observed for oxcarbazepine (mean 3.75, range 0.5-7.0, n = 2), whereas the lowest were observed for valproate (mean 0.04, range 0.01-0.22, n = 121).
We observed substantial variability between anticonvulsants and lithium regarding their ability to enter fetal/newborn circulation. Assessing concentrations of anticonvulsants and lithium in maternal samples can provide a surrogate of fetal/infant exposure, although patterns of concentration-dependent effects for maternal/neonatal safety are lacking.
We conducted a systematic literature search in PubMed/EMBASE for studies with concentrations of anticonvulsants/lithium from maternal blood, amniotic fluid, umbilical cord blood and/or breast milk. Penetration ratios were calculated by dividing the concentrations in amniotic fluid, umbilical cord plasma or breast milk by the maternal concentrations. When data from multiple studies were available, we calculated combined penetration ratios, weighting studies\' mean by study size.
Ninety-one eligible studies for brivaracetam, carbamazepine, clonazepam, ethosuximide, gabapentin, lacosamide, lamotrigine, levetiracetam, lithium, oxcarbazepine, perampanel, phenobarbital, phenytoin, pregabalin, primidone, topiramate, valproate, vigabatrin and zonisamide were identified. For amniotic fluid, the highest penetration ratios were estimated for levetiracetam (mean 3.56, range 1.27-5.85, n = 2) and lowest for valproate (mean 0.11, range 0.02-1.02, n = 57). For umbilical cord plasma, oxcarbazepine had the highest ratio (mean 1.59, range 0.11-4.33, n = 12) with clonazepam having the lowest (mean 0.55, range 0.52-0.59, n = 2). For breast milk, the highest ratios were observed for oxcarbazepine (mean 3.75, range 0.5-7.0, n = 2), whereas the lowest were observed for valproate (mean 0.04, range 0.01-0.22, n = 121).
We observed substantial variability between anticonvulsants and lithium regarding their ability to enter fetal/newborn circulation. Assessing concentrations of anticonvulsants and lithium in maternal samples can provide a surrogate of fetal/infant exposure, although patterns of concentration-dependent effects for maternal/neonatal safety are lacking.
摘要：
目的：关于抗惊厥药和锂进入胎儿和新生儿循环能力的数据已经越来越多；在这里，我们估计了一系列接受抗惊厥药或锂治疗的孕妇/哺乳期妇女的组合样本中的穿透率。
方法：我们在PubMed/EMBASE中进行了系统的文献检索，以研究抗惊厥药/母体血液中的锂浓度，羊水,脐带血和/或母乳。通过除以羊水中的浓度来计算渗透比，脐带血浆或母乳由母体浓度。当多项研究的数据可用时，我们计算了综合穿透率，加权研究按研究规模计算的平均值。
结果：91项符合资格的布立西坦研究，卡马西平,氯硝西泮,乙苏肟,加巴喷丁,拉科沙胺,拉莫三嗪,左乙拉西坦,锂，奥卡西平,Perampanel,苯巴比妥,苯妥英,普瑞巴林,普米酮,托吡酯,丙戊酸盐,鉴定了vigabatrin和zonisamide。对于羊水，左乙拉西坦的渗透率最高(平均3.56,范围1.27-5.85,n=2),丙戊酸盐的渗透率最低(平均0.11,范围0.02-1.02,n=57).对于脐带血浆，奥卡西平的比率最高（平均1.59，范围0.11-4.33，n=12），氯硝西泮的比率最低（平均0.55，范围0.52-0.59，n=2）。对于母乳，最高的比率是观察到的奥卡西平（平均3.75，范围0.5-7.0，n=2），而最低的是丙戊酸盐（平均0.04，范围0.01-0.22，n=121）。
结论：我们观察到抗惊厥药和锂进入胎儿/新生儿循环的能力之间存在显著差异。评估孕妇样本中抗惊厥药和锂的浓度可以替代胎儿/婴儿暴露，尽管缺乏对孕产妇/新生儿安全的浓度依赖性效应模式。
方法：我们在PubMed/EMBASE中进行了系统的文献检索，以研究抗惊厥药/母体血液中的锂浓度，
结果：91项符合资格的布立西坦研究，
结论：我们观察到抗惊厥药和锂进入胎儿/新生儿循环的能力之间存在显著差异。
