妊娠とてんかん

Safe and Effective Management of Epilepsy in Pregnancy

女性のてんかん患者では，妊娠前から内服調整や葉酸の補充が求められる。催奇形リスクの低い抗てんかん薬を選択し，発作のコントロールに必要な最小限の投与量を目指す。また，妊娠に伴って発作頻度が変わる可能性や自然分娩に向けた対応，抗てんかん薬の内服下でも授乳が可能であることなど，適切な情報提供も重要である。産科や精神科など必要な診療科と連携し，安心した環境で妊娠・出産が迎えられるよう調整を図る。

Abstract

In women with epilepsy, antiepileptic drugs with low teratogenic risk should be used at the lowest dose necessary to control seizures. The medication adjustment and folic acid supplementation are started before pregnancy. Valproic acid should be avoided unless indispensable. Levetiracetam and lamotrigine are often used as less teratogenic agents. Moreover, appropriate information on possible changes in seizure frequency with pregnancy and childbirth preparation and breastfeeding should be provided. Generally, women taking antiepileptic drugs for epilepsy treatment may undergo natural delivery and breastfeeding. We should collaborate with obstetricians and other professionals to help ensure a safe environment for pregnancy and childbirth.