The Use of Antidepressant Drugs in Pregnant Women With Epilepsy: A Study From the Australian Pregnancy Register Sivathamboo N, Hitchcock A, Graham J, et al. Epilepsia. 2018;59(9):1696-1704. OBJECTIVE To study interactions between first-trimester exposure to antidepressant drugs (ADDs) and antiepileptic drugs (AEDs) and a history of clinical depression and/or anxiety on pregnancy outcomes and seizure control in pregnant women with epilepsy (WWE). METHODS We examined data from the Australian Pregnancy Register of Antiepileptic Drugs in Pregnancy, collected from 1999 to 2016. The register is an observational, prospective database, from which this study retrospectively analyzed a cohort. Among the AED-exposed outcomes, comparisons were made among 3 exposure groups: (1) pregnancy outcomes with first-trimester exposure to ADDs, (2) outcomes with mothers diagnosed with depression and/or anxiety but who were not medicated with an ADD, and (3) those with mothers who were not diagnosed with depression and/or anxiety and were not medicating with ADD. Prevalence data were analyzed using Fisher exact test. RESULTS A total of 2124 pregnancy outcomes were included in the analysis; 1954 outcomes were exposed to AEDs in utero, whereas 170 were unexposed. Within the group of WWE taking AEDs, there was no significant difference in the prevalence of malformations in infants who were additionally exposed to ADDs (10.2%; 95% confidence interval [CI]: 3.9-16.6), compared to individuals in the non-ADD-medicated depression and/or anxiety group (7.7%, 95% CI: 1.2-14.2), or those without depression or anxiety (6.9%, 95% CI: 5.7-8.1; P = .45). The malformation rates in pregnancy outcomes unexposed to AEDs were also similar in the above groups ( P = .27). In WWE medicated with AEDs and ADDs, the frequency of convulsive seizures ( P = .78), or nonconvulsive seizures ( P = .45) throughout pregnancy, did not differ across comparative groups. SIGNIFICANCE Comedicating with ADDs in WWE taking AEDs does not appear to confer a significant added teratogenic risk, and it does not affect seizure control.

中文翻译：

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抗癫痫药对癫痫孕妇是否安全？迹象表明是。

抗癫痫药在癫痫孕妇中的使用：来自澳大利亚妊娠登记机构Sivathamboo N，Hitchcock A，Graham J等的一项研究。癫痫病。2018; 59（9）：1696-1704。目的研究妊娠期癫痫孕妇（WWE）在妊娠前三个月接触抗抑郁药（ADDs）和抗癫痫药（AEDs）与临床抑郁和/或焦虑史对妊娠结局和癫痫发作控制的关系。方法我们研究了从1999年至2016年收集的澳大利亚妊娠抗癫痫药物妊娠登记簿中的数据。该登记簿是一个观察性前瞻性数据库，该研究从该研究中回顾性分析了一个队列。在AED暴露结局中，对3个暴露组进行了比较：（1）妊娠结局与孕早期ADDs暴露，（2）被诊断患有抑郁和/或焦虑但未接受ADD治疗的母亲的预后，以及（3）未诊断患有抑郁和/或焦虑且未进行ADD治疗的母亲的预后。使用Fisher精确检验分析患病率数据。结果分析共计2124例妊娠结局。1954年的结果在子宫内暴露于AED，而170例未暴露。在WWE服用AED的人群中，与未接受ADD的婴儿相比，接受ADD婴儿的畸形患病率无明显差异（10.2％； 95％置信区间[CI]：3.9-16.6）。 ADD药物治疗的抑郁和/或焦虑组（7.7％，95％CI：1.2-14.2），或无抑郁或焦虑的患者（6.9％，95％CI：5.7-8.1； P = .45）。在上述组中，未暴露于AED的妊娠结局中畸形率也相似（P = 0.27）。在使用AED和ADD进行药物治疗的WWE中，整个怀孕期间惊厥性发作（P = .78）或非惊厥性癫痫发作（P = .45）的发生频率在比较组之间没有差异。重要性在WWE中服用AED的ADDs的喜剧性治疗似乎并未带来显着的致畸风险，并且不影响癫痫发作的控制。