No abstract

Objectives: Epidemiological data indicate that the pregnancies of epileptic women constitute about 1% of all pregnancies. A large group of antiepileptic drugs (AEDs) applied in long-term monotherapy or polytherapy produce toxic metabolites as well as free radicals and reactive oxygen species. The aim of this study was to assess the potential genotoxic effect of AED therapy in pregnancy on DNA structure of umbilical cord blood lymphocytes. Material and Methods: The study group were 30 newborns (14 males and 16 females) of mothers receiving long-term AED therapy during pregnancy. The AED considered were carbamazepine, valproic acid, phenyltriazine, benzodiazepine, gamma-aminobutyric acid and sulfonamide analogues. The controls were infants born to mothers not exposed to any medication in pregnancy (n = 20). Positive controls were the same infants, but in this case Nitrogranulogen (Sigma) was added to the collected cord blood samples (n = 11). Micronucleus (MN) assay was used as an indicator of chromosome damage. The frequency (%) of MN/1000 binucleated cells and the nuclear division index (NDI) were calculated. Results: Mean MN frequency and NDI were respectively 0.110 (±0.152), 1.592 (±0.206) in the study group and 0.050 (±0.061), 1.628 (±0.178) in the controls (statistically non-signifi cant difference, p > 0.1). Conclusion: The fi ndings did not reveal any genotoxic effect or inhibition of nuclear division in cord blood lymphocytes by AED metabolites. This was refl ected by the absence of signifi cant between-group differences in the mean MN frequency and NDI.

Thirty fetuses with Down syndrome, who had detailed fetal echocardiography and sonography at the tertiary center with videotape recordings, were retrospective analyzed by one observer with a specially prepared flow sheet. The mean gestational age of the fetuses at the time of the study was 31 ± 5.6 (minimum 21, maximum 39) weeks. The ‘main’ fetal abnormalities were congenital heart defect (CHD): in 13 cases (43.3%) an abnormal 4-chamber view was recorded, including 6 cases (20%) of isolated CHD and 7 (23.3%) of coexisting CHD + extracardiac malformation. Of the 13 cases of CHD, there were 12 cases of atrio-ventricular canal and 1 case of ventricular septal defect. Normal heart anatomy was recorded in 17 cases (56.7%), including 2 with tricuspid value regurgitation. From the videotape recordings also some ‘minor’ abnormalities were noticed in a few cases such as: femur length shortening; sandal gap; pericardial effusion; macroglossia; echogenic bowel; absent diastolic flow in the umbilical artery, and others. The prevalence of CHD in the study group was similar to the prevalence of CHD in the comparison group of 20 newborns with Down syndrome, born during the same period of time at the same institution, who had not had prenatal scanning at all (χ², p > 0.05). Conclusions: (1) the main ‘major’ abnormality which might be detected in a fetus with Down syndrome after 20 weeks of pregnancy is CHD, which was presented in 43.3% of this series; (2) the presence of any extracardiac malformation should prompt the sonographer for detailed heart evaluation, and (3) fetal echocardiography may increase the accuracy of ‘genetic sonogram’ in Down syndrome.