Mogući negativni učinci primjene antiepileptika tijekom trudnoće

master's thesis

• Title (english): Possible adverse effects of antiepileptic therapy in pregnancy
• Author: Nikolina Friščić
• Mentor: Alenka Boban Blagaić (mentor)
• Committee member: Ante Tvrdeić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Alenka Boban Blagaić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pharmacology); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Basic Medical Sciences; Pharmacology

Abstract

Epilepsija je jedna od najučestalijih neuroloških bolesti današnjice. Također se smatra drugom najčešćom neurološkom bolesti u trudnoći. Povijesno se primjena antiepileptika tijekom trudnoće povezala s nizom neželjenih učinaka, što je dovelo do razmatranja potrebe nastavka terapije u trudnoći. Međutim, većini žena koje boluju od epilepsije preporuča se nastavak terapije tijekom trudnoće, kako bi se održala kontrola napadaja, a time i spriječio nastup neželjenih učinaka koji mogu ugroziti kako majku, tako i plod. Primjena antiepileptika u trudnoći dodatno je otežana fiziološkim promjenama do kojih dolazi tijekom trudnoće, a koje mogu utjecati na promjenu farmakokinetike lijekova. Stoga najveći izazov u terapiji epilepsije tijekom trudnoće predstavlja postizanje ravnoteže između koristi primjene antiepileptika i rizika javljanja nuspojava. Jedan od najtežih oblika nuspojava predstavljaju kongenitalne malformacije ploda. Dokazivanje teratogenog potencijala pojedinog antiepileptika iznimno je teško. Naime, podatci o povezanosti primjene određenog antiepileptika tijekom trudnoće i pojave kongenitalnih malformacija najčešće se dobivaju iz trudničkih registara. Većina starijih antiepileptika ima već poznat teratogeni potencijal, a utvrđivanje teratogenog potencijala prilikom primjene novijih antieplieptika predstavlja problem zbog male veličine uzorka, kao i problema činjenice da je terapija antiepilepsije u trudnoći većinom polifarmakološka. Nažalost, većina dosadašnjih studija teratogenih učinaka antiepileptika nije imala dovoljnu jačinu dokaza da bi dovela do značajnijih zaključaka o odnosu dobrobiti i riziku primjene ovih lijekova u trudnoći. No, bez obzira na neželjene učinke koji se mogu javiti prilikom primjene antiepileptika u trudnoći, većina žena koje boluju od epilepsije imat će urednu trudnoću, koja će rezultirati rođenjem zdravoga djeteta.

Abstract (english)

Epilepsy is one of the most common neurological diseases of today. It is also considered the second most common neurological disease in pregnancy. Historically, the use of antiepileptic drugs during pregnancy is connected with a number of adverse effects, which has led to considering the need of continuing therapy during pregnancy. However, it is recommended for women with epilepsy to continue antiepileptic therapy during pregnancy in order to maintain seizure control and prevent the appearance of adverse effects that can endanger both mother and fetus. The use of AEDs in pregnancy is exacerbated by the physiological changes that occur during pregnancy, which may affect the pharmacokinetics of drugs. Therefore, the greatest challenge in the treatment of epilepsy during pregnancy is maintaining a balance between the benefits of AEDs and the risk of side effects. One of the most serious side effects are congenital malformations of the fetus. Proving teratogenic potential of individual antiepileptic drugs is extremely difficult. Data on the application of certain antiepileptic drugs during pregnancy and the occurrence of congenital malformations are most often obtained from maternity registers. Older AEDs already have known teratogenic potential but determining teratogenic potential of newer AEDs remains a problem because of the small sample size and the use of these AEDs as a part of a polytherapy. Unfortunately, previous studies of teratogenic effects of AEDs did not have sufficient strength of evidence that would lead to significant conclusions about the relative benefits and risks of application of these drugs in pregnancy. But regardless of the adverse effects that may occur during the use of AEDs during pregnancy, most women with epilepsy will have a normal pregnancy, which will result with the birth of a healthy child.

• Keywords: epilepsija; trudnoća; antiepileptici; teratogenost; kongenitalne malformacije
• Keywords (english): epilepsy; pregnancy; antiepileptic drugs; teratogenicity; congenital malformations
• Language: croatian
• URN:NBN: urn:nbn:hr:105:013186
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-08-11 08:36:47