Epilepsy and Pregnancy: Maternal and Fetal Effects of Phenytoin

Brewer, Joyce M.; Waltman, Patricia A.

doi:10.4037/ccn2003.23.2.93

Cited by 8 publications

(13 citation statements)

References 17 publications

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“…A hipertrofia gengival ocorre em mais de 45% dos pacientes. 62,63 O padrão de anomalias fetais associadas ao uso da fenitoína foi descrito inicialmente em 1975 e incluia: fácies dismórfica, anomalias cardíacas, fenda labial e palatina, hipoplasia digital com unhas pequenas e diminuição do perímetro cefálico. 25 A depuração da fenitoína aumenta cerca de 20% durante a gravidez, o que pode se associar a um aumento na freqüência de crises.…”

Section: Fenitoínaunclassified

Tratamento de gestantes com epilepsia: papel dos medicamentos antiepilépticos clássicos e novos

Hirama

Dias

Matsudo

et al. 2008

J. epilepsy clin. neurophysiol.

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As epilepsias constituem a doença neurológica crônica grave mais comum e têm implicações terapêuticas relacionadas ao sexo. As informações sobre os riscos do uso das drogas antiepilépticas clássicas e novas durante a gestação são muito importantes tanto para a saúde da mulher quanto para a do feto. OBJETIVO: Realizar uma revisão da literatura referente aos aspectos terapêuticos das gestantes com epilepsia. MÉTODO: Revisão da literatura com o uso das palavras chave: epilepsia/crises/convulsões e gestação, drogas antiepilépticas, farmacocinética, teratogênese, malformações e uso de folato/ácido fólico. DISCUSSÃO E CONCLUSÃO: As metodologias utilizadas são muito variáveis além de ocorrerem complicações decorrentes do uso das novas drogas. A contribuição do uso das DAE novas e tradicionais, sua farmacocinética e a ocorrência de epilepsia/crises na gestação podem prejudicar a evolução da gravidez e não têm sido claramente delineadas. Os autores enfatizam a necessidade de estudos para avaliar o impacto da epilepsia e seu tratamento na vida reprodutiva, a fim de otimizar seu tratamento, além da necessidade de estudos farmacocinéticos durante a gestação para obtenção de melhores resultados terapêuticos e também para a diminuição dos efeitos nocivos das drogas sobre a mãe e o feto.

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Section: Fenitoínaunclassified

Tratamento de gestantes com epilepsia: papel dos medicamentos antiepilépticos clássicos e novos

Hirama

Dias

Matsudo

et al. 2008

J. epilepsy clin. neurophysiol.

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“…It is uncertain if the problems associated with epilepsy in pregnancy are secondary to the genetics of the disorder, seizures, or use of antiepileptic drugs (AEDs). [1][2][3][4] Reported complications include fetal anomalies, spontaneous abortion, stillbirth, placental defects, abruption, preterm labor, preeclampsia, and hemorrhage. 3 Although some sources report a two-to fourfold increase in the rate of spontaneous abortion, pregnancy-induced hypertension, and preterm labor, 2 other research has found the majority of women with epilepsy have uncomplicated pregnancies.…”

Section: Effect Of Epilepsy On Pregnancymentioning

confidence: 99%

“…1 In adults, adverse effects can include peripheral neuropathy, vitamin D and K deficiencies, and folate deficiency with resultant megaloblastic anemia. 2 Gingival hyperplasia develops in more than 45% of users. 2 A pattern of fetal anomalies associated with hydantoin, of which phenytoin is a derivative, was first described in the literature in 1975.…”

Section: Effect Of Phenytoin Use During Pregnancymentioning

confidence: 99%

“…2 Gingival hyperplasia develops in more than 45% of users. 2 A pattern of fetal anomalies associated with hydantoin, of which phenytoin is a derivative, was first described in the literature in 1975. 1,7 The characteristics of fetal hydantoin syndrome include IUGR with small head circumference, dysmorphic facies, orofacial clefts, cardiac defects, and distal digital hypoplasia with small nails.…”

Section: Effect Of Phenytoin Use During Pregnancymentioning

confidence: 99%

“…7 Today, the known potential adverse effects of phenytoin on the fetus include facial clefting, vitamin K and D deficiencies, heart malformations, limb deformities, and neurologic defects. 2 Although folate supplementation is recommended for pregnant women taking the drug, the efficacy of folate supplementation in preventing neural tube defects is unproved. 1,7 The provider needs to be aware that increased folate intake in the mother may speed phenytoin metabolism through the synergistic drug-vitamin interaction and thereby lower her serum phenytoin levels.…”

Section: Effect Of Phenytoin Use During Pregnancymentioning

confidence: 99%

See 2 more Smart Citations

Use of Phenytoin in Pregnancy for Epileptic Seizure Prevention: A Case Report

Fitzgerald

2004

J Midwife Womens Health

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Epilepsy is the most common neurological disorder in women of reproductive age. Phenytoin is one of the most frequently prescribed antiepileptic drugs. Although the vast majority of women with epilepsy have normal pregnancy outcomes, certain fetal anomalies and pregnancy complications are associated with epilepsy and phenytoin use. Appropriate midwifery care of women with epilepsy includes consultation and co-management with an obstetrician and a neurologist. The clinical course of a woman with epilepsy taking phenytoin is presented.

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Recent Changes in Pregnancy and Lactation Labeling: Retirement of Risk Categories

Ramoz

Patel-Shori

2014

Pharmacotherapy

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The rapid development and increased availability of novel pharmacologic therapies and pharmaceutical products has amplified the potential for drug exposure during pregnancy. Many drugs are beneficial for disease state management during pregnancy and provide significant fetal and maternal health benefits. However, a paucity of safety data combined with the imprecision of the current risk category system renders risk versus benefit assessment difficult. In response to decades of criticism, the U.S. Food and Drug Administration (FDA) is implementing a new pregnancy and lactation labeling rule designed to improve risk versus benefit assessment of drugs used in pregnant and nursing mothers. These recommendations will provide clear and detailed information for both patients and health care providers, and they will include three main categories: risk summary, clinical considerations, and data. The new labeling rules remove the previous letter risk categorization system (A, B, C, D, X). In this review, we summarize the upcoming FDA labeling changes and discuss their potential consequences on clinical practice.

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Epilepsy and Pregnancy: Maternal and Fetal Effects of Phenytoin

Cited by 8 publications

References 17 publications

Tratamento de gestantes com epilepsia: papel dos medicamentos antiepilépticos clássicos e novos

Tratamento de gestantes com epilepsia: papel dos medicamentos antiepilépticos clássicos e novos

Use of Phenytoin in Pregnancy for Epileptic Seizure Prevention: A Case Report

Recent Changes in Pregnancy and Lactation Labeling: Retirement of Risk Categories

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