Kwabesifazane abaneminyaka yobudala yokuzala abanesithuthwane, ukuphepha kwezidakamizwa ezilwa nokuthunjwa kubalulekile kubo kanye nenzalo yabo, njengoba imithi ivame ukudingeka ngesikhathi sokukhulelwa nokuncelisa ukuze kuncishiswe imiphumela yokuquleka. Ukuthi ukuthuthukiswa kwesitho somntwana kuyathinteka yini ngokwelashwa kwemithi kamama elwa nesithuthwane ngesikhathi sokukhulelwa kuyakhathaza. Ucwaningo lwangaphambilini luphakamise ukuthi phakathi kwezidakamizwa zendabuko zokulwa nokuquleka, i-valproic acid, i-phenobarbital, ne-carbamazepine ingase iveze ubungozi be-teratogenic. Phakathi kwemishanguzo emisha yokunqanda ukuthunjwa, i-lamotrigine ibhekwa njengephephile uma kuqhathaniswa nengane, kuyilapho i-topiramate ingase yandise ingozi yokuvuleka komlomo nolwanga lwengane.
Ucwaningo oluningana lwe-neurodevelopmental lubonise ukuhlobana phakathi kokusetshenziswa komama kwe-valproic acid ngesikhathi sokukhulelwa kanye nokuncipha kokusebenza kwengqondo, i-autism, kanye ne-attention deficit hyperactivity disorder (ADHD) ebantwaneni. Kodwa-ke, ubufakazi bekhwalithi ephezulu mayelana nobudlelwano phakathi kokusetshenziswa kwe-topiramate yomama ngesikhathi sokukhulelwa kanye ne-neurodevelopment yenzalo ihlala inganele. Ngokujabulisayo, ucwaningo olusha olushicilelwe ngesonto eledlule ku-New England Journal of Medicine (NEJM) lusilethela ubufakazi obengeziwe
Emhlabeni wangempela, izinhlolo ezinkulu ezilawulwa ngokungahleliwe azinakwenzeka kwabesifazane abakhulelwe abanesifo sokuwa abadinga imishanguzo yokunqanda ukugwinya ukuze baphenye ukuphepha kwemithi. Ngenxa yalokho, ukubhaliswa kokukhulelwa, izifundo zeqoqo, kanye nezifundo zokulawula izimo seziphenduke imiklamo yocwaningo esetshenziswa kakhulu. Ngokombono we-methodological, lolu cwaningo lungolunye lwezifundo ezisezingeni eliphezulu ezingasetshenziswa njengamanje. Okugqamile kwayo yilokhu okulandelayo: indlela yocwaningo lwamasampula amakhulu esekelwe kubantu iyamukelwa. Nakuba umklamo ubuyela emuva, idatha ivela kumininingwane emibili emikhulu yezwe ye-US Medicaid ne-Medicare izinhlelo eziye zabhaliswa ngaphambili, ngakho ukuthembeka kwedatha kuphezulu; Isikhathi sokulandelela esimaphakathi kwakuyiminyaka engu-2, eyayihlangabezana nesikhathi esidingekayo sokuxilongwa kwe-autism, futhi cishe i-10% (amacala angaphezu kuka-400,000 esewonke) alandelwa iminyaka engaphezu kwe-8.
Lolu cwaningo beluhlanganisa nabesifazane abakhulelwe abafanelekile abangaphezu kwezigidi ezine, abangu-28,952 kubo kwatholakala ukuthi banesifo sokuwa. Abesifazane bahlukaniswa ngokuya ngokuthi babedla yini imishanguzo evimbela isithuthwane noma imishanguzo ehlukene ye-antiepileptic ngemva kwamasonto angu-19 okukhulelwa (isiteji lapho ama-synapses eqhubeka ukwakheka). I-Topiramate yayiseqenjini eliveziwe, i-valproic acid yayiseqenjini lokulawula elihle, kanti i-lamotrigine yayiseqenjini lokulawula elibi. Iqembu lokulawula elingadalulwanga lalihlanganisa bonke abesifazane abakhulelwe ababengathathi noma yimiphi imithi elwa nokuthunjwa kusukela ezinsukwini ezingu-90 ngaphambi kwesikhathi sabo sokugcina sokuya esikhathini kuya esikhathini sokubeletha (okuhlanganisa nesifo sokuwa esingasebenzi noma esingalashwa).
Imiphumela yabonisa ukuthi isilinganiso sokuqongelela kwezehlakalo ze-autism eminyakeni eyi-8 sasingu-1.89% phakathi kwayo yonke inzalo engazange itholakale kunoma yimiphi imithi ye-antiepileptic; Phakathi kwezingane ezizalwa omama abanesifo sokuwa, ukwanda kwe-autism kwaba ngu-4.21% (95% CI, 3.27-5.16) ezinganeni ezingazange zichayeke emithini ye-antiepileptic. Izehlakalo ezikhulayo ze-autism ezinganeni ezichayeke ku-topiramate, i-valproate, noma i-lamotrigine zazingu-6.15% (95% CI, 2.98-9.13), 10.51% (95% CI, 6.78-14.24), kanye no-4.08% (95% 5-7), ngokulandelana.
Uma kuqhathaniswa nezinsana ezingavezwanga emithini ye-antiseizure, ubungozi be-autism obulungiselwe imiphumela yokuthambekela kwaba kanje: Bekuyi-0.96 (95% CI, 0.56~1.65) eqenjini lokuchayeka ku-topiramate, 2.67 (95% CI, 1.69~4.20) kuqembu le-valproic, 09% exposure, 51% ye-asidi. 0.69~1.46) eqenjini lokuchayeka i-lamotrigine. Ekuhlaziyweni kweqembu elingaphansi, ababhali bafinyelela iziphetho ezifanayo ngokusekelwe ekutheni iziguli zithole i-monotherapy, umthamo wokwelashwa kwezidakamizwa, nokuthi ngabe kukhona ukuchayeka kwezidakamizwa okuhlobene ekukhulelweni kokuqala.
Imiphumela yabonisa ukuthi inzalo yabesifazane abakhulelwe abanesithuthwane yayisengozini enkulu yokuba ne-autism (amaphesenti angu-4.21). Ayikho i-topiramate noma i-lamotrigine eyandisa ingozi ye-autism enzalweni yomama abasebenzisa izidakamizwa ezivimbela ukuthuthumela ngesikhathi sokukhulelwa; Kodwa-ke, lapho i-valproic acid ithathwa ngesikhathi sokukhulelwa, kwakunengozi eyengeziwe encike kumthamo we-autism enzalweni. Nakuba lolu cwaningo lugxile kuphela ezenzweni ze-autism enzalweni yabesifazane abakhulelwe abasebenzisa izidakamizwa ezivimbela ukuthuthumela, futhi aluzange luhlanganise eminye imiphumela evamile ye-neurodevelopmental njengokuncipha komqondo enzalweni kanye ne-ADHD, lusabonisa ubuthaka be-neurotoxicity uma kuqhathaniswa ne-topiramate enzalweni uma kuqhathaniswa ne-valproate.
I-Topiramate ngokuvamile ayibhekwa njengento efanelekayo esikhundleni se-valproate ye-sodium ngesikhathi sokukhulelwa, ngoba ingandisa ingozi yokuqhekeka kwezindebe nolwanga futhi encane ngesikhathi sokukhulelwa. Ngaphezu kwalokho, kukhona ucwaningo oluphakamisa ukuthi i-topiramate ingandisa ingozi yokuphazamiseka kwe-neurodevelopmental ezinganeni. Kodwa-ke, ucwaningo lwe-NEJM lubonisa ukuthi uma kuphela kucatshangelwa umphumela ku-neurodevelopment yenzalo, kwabesifazane abakhulelwe abadinga ukusebenzisa i-valproate nge-anti-epileptic seizures, kuyadingeka ukwandisa ingozi yokuphazamiseka kwe-neurodevelopmental kubantwana. I-Topiramate ingasetshenziswa njengomuthi ohlukile. Kufanele kuqashelwe ukuthi inani labantu baseziqhingini zase-Asia kanye nabanye baseziqhingini zase-Pacific kulo lonke iqoqo liphansi kakhulu, libalelwa ku-1% kuphela weqembu lonke, futhi kungase kube nomehluko wobuhlanga ekuphenduleni okungekuhle emithini elwa nokuquleka, ukuze ngabe imiphumela yalolu cwaningo inganwetshwa ngokuqondile kubantu base-Asia (kuhlanganise nabantu baseShayina) idinga ukuqinisekiswa abantu abaningi base-Asia ocwaningweni oluzayo.
Isikhathi sokuthumela: Mar-30-2024