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Kwabasetyhini abakwiminyaka yokuzala abanesithuthwane, ukhuseleko lwamachiza okulwa nokuxhuzula lubalulekile kubo nakwinzala yabo, njengoko amayeza ahlala efuneka ngexesha lokukhulelwa nokuncancisa ukunciphisa imiphumo yokuxhuzula. Ingaba ukuphuhliswa kwelungu lomntwana okhulelweyo kuchatshazelwa kunyango lweyeza lokulwa ne-antiepileptic ngexesha lokukhulelwa liyinkxalabo. Uphononongo oludlulileyo lucebise ukuba phakathi kwamachiza emveli achasene nokuxhuzula, i-valproic acid, i-phenobarbital, kunye ne-carbamazepine inokubonisa imingcipheko ye-teratogenic. Phakathi kwamachiza amatsha okulwa nokuxhuzula, i-lamotrigine ithathwa njengekhuselekile ngokwentelekiso kusana olungekazalwa, ngelixa i-topiramate inokunyusa umngcipheko wokucandeka komlebe we-fetus kunye nenkalakahla.

Izifundo ezininzi ze-neurodevelopmental zibonise unxulumano phakathi kokusetyenziswa komama kwe-valproic acid ngexesha lokukhulelwa kunye nokuncipha kokusebenza kwengqondo, i-autism, kunye nokusilela kwengqwalasela ye-hyperactivity disorder (ADHD) kwinzala. Nangona kunjalo, ubungqina obuphezulu bobudlelwane phakathi kokusetyenziswa kwe-topiramate yoomama ngexesha lokukhulelwa kunye ne-neurodevelopment yenzala ihlala inganele. Ngombulelo, isifundo esitsha esipapashwe kwiveki ephelileyo kwiNew England Journal of Medicine (NEJM) isizisa ubungqina obuninzi

Ehlabathini lokwenyani, ulingo olukhulu olulawulwa ngokungenamkhethe alunakwenzeka kwabasetyhini abakhulelweyo abanesifo sokuwa abafuna amayeza okulwa nokuxhuzula ukuphanda ukhuseleko lwamachiza. Ngenxa yoko, iirejistri zokukhulelwa, izifundo zamaqela, kunye nezifundo zolawulo lwemeko ziye zaba zezona zisetyenziswa kakhulu ziyilo lophononongo. Ukusuka kwimbono yemethodological, olu phononongo sesinye sezifundo ezikumgangatho ophezulu ezinokuthi ziphunyezwe ngoku. Amagqabantshintshi ayo ngolu hlobo lulandelayo: indlela yophononongo lwesampulu enkulu esekwe kubemi yamkelwe. Nangona uyilo luyi-retrospective, idatha ivela kwiinkcukacha ezimbini zelizwe ezinkulu ze-US Medicaid kunye ne-Medicare iinkqubo eziye zabhaliswa ngaphambili, ngoko ukuthembeka kwedatha kuphezulu; Ixesha lokulandelela eliphakathi laliyiminyaka eyi-2, eyona nto yadibana nexesha elifunekayo lokuxilongwa kwe-autism, kwaye phantse i-10% (ngaphezu kweemeko ze-400,000 zizonke) zalandelwa ngaphezu kweminyaka eyi-8.

Uphononongo lubandakanya ngaphezu kwe-4 yezigidi zabasetyhini abakhulelweyo abafanelekileyo, i-28,952 kubo yafunyaniswa ukuba inesifo sokuwa. Abasetyhini bahlelwa ngokwendlela yokuba ngaba bathatha amayeza e-antiepileptic okanye amayeza ahlukeneyo e-antiepileptic emva kweeveki ezili-19 zokumitha (inqanaba apho i-synapses iqhubeka ukuvela). I-Topiramate yayiseqela elibonakalayo, i-valproic acid yayikwiqela elilawulayo elihle, kwaye i-lamotrigine yayikwiqela elilawulayo elibi. Iqela elingabonakaliyo elilawulayo libandakanya bonke abafazi abakhulelweyo ababengathathi nawaphi na amayeza okulwa ne-anti-seizure ukusuka kwiintsuku ze-90 ngaphambi kwexesha lokugqibela lokuya esikhathini ukuya kwixesha lokubeleka (kwakhona kubandakanywa ne-epilepsy engasebenziyo okanye engaphathwanga).

Iziphumo zibonise ukuba uqikelelo lwezehlo ze-autism kwiminyaka eyi-8 yayiyi-1.89% phakathi kwayo yonke inzala engakhange ivelele kuwo nawaphi na amachiza e-antiepileptic; Phakathi kwenzala ezelwe ngoomama abaxhuzulayo, ukwanda kwe-autism kwaba yi-4.21% (95% CI, 3.27-5.16) kubantwana abangazange bavezwe ngamachiza e-antiepileptic. Isiganeko esongezelekayo se-autism kwinzala evezwe kwi-topiramate, i-valproate, okanye i-lamotrigine yayingu-6.15% (95% CI, 2.98-9.13), 10.51% (95% CI, 6.78-14.24), kunye ne-4.08% (95% 5-7), ngokulandelanayo.

Xa kuthelekiswa ne-fetus engabonakali kwiziyobisi ze-antiseizure, umngcipheko we-autism ulungelelaniswa kumanqaku okuthambekela kwaba ngolu hlobo lulandelayo: Yayiyi-0.96 (95% CI, 0.56 ~ 1.65) kwiqela le-topiramate exposure, 2.67 (95% CI, 1.69 ~ 4.20) kwiqela le-valproic, i-51% ye-asidi exposure, i-51% ye-asidi exposure. 0.69 ~ 1.46) kwiqela le-lamotrigine exposure. Kucazululo lweqela elingaphantsi, ababhali benza izigqibo ezifanayo ngokusekelwe ekubeni izigulane zifumene i-monotherapy, idosi yonyango lweziyobisi, kunye nokuba kukho ukuvezwa kweziyobisi ezinxulumene nokukhulelwa kwangaphambili.

Iziphumo zabonisa ukuba inzala yabasetyhini abakhulelweyo abanesithuthwane babenomngcipheko ophezulu we-autism (i-4.21 ekhulwini). Ayikho i-topiramate okanye i-lamotrigine eyandisa umngcipheko we-autism kwinzala yoomama abathatha iziyobisi ezichasayo ngexesha lokukhulelwa; Nangona kunjalo, xa i-valproic acid ithathwa ngexesha lokukhulelwa, kwakukho umngcipheko okhulayo oxhomekeke kwithamo le-autism kwinzala. Nangona uphononongo lugxile kuphela kwizehlo ze-autism kwinzala yabasetyhini abakhulelweyo abathatha amachiza okulwa, kwaye aluzange lufake ezinye iziphumo eziqhelekileyo ze-neurodevelopmental ezifana nokuncipha kwengqondo kwinzala kunye ne-ADHD, lisabonisa ubuthathaka be-neurotoxicity ye-topiramate kwinzala xa ithelekiswa ne-valproate.

I-Topiramate ngokuqhelekileyo ayithathwa njengento efanelekileyo endaweni ye-valproate ye-sodium ngexesha lokukhulelwa, kuba inokunyusa umngcipheko wokuqhawula umlebe kunye nenkalakahla kwaye encinci kwi-gestational age. Ukongeza, kukho izifundo ezicebisa ukuba i-topiramate inokunyusa umngcipheko wokuphazamiseka kwe-neurodevelopmental kwinzala. Nangona kunjalo, uphando lwe-NEJM lubonisa ukuba ukuba kuqwalaselwa kuphela umphumo kwi-neurodevelopment yenzala, kubafazi abakhulelweyo abafuna ukusebenzisa i-valproate kwi-anti-epileptic seizures, kuyimfuneko yokwandisa umngcipheko wokuphazamiseka kwe-neurodevelopmental kwinzala. I-Topiramate ingasetyenziselwa njengenye iyeza. Kufuneka kuqatshelwe ukuba inani labantu base-Asiya kunye nabanye abantu beziqithi zePasifiki kulo lonke iqela liphantsi kakhulu, libalelwa kwi-1% kuphela yeqela lilonke, kwaye kunokubakho ukungafani kobuhlanga kwiimpembelelo ezichaseneyo neziyobisi ezichasene nokuxhuzula, ngoko ke nokuba iziphumo zolu phononongo zinokwandiswa ngokuthe ngqo kubantu base-Asiya (kubandakanywa nabantu baseTshayina) kufuneka ziqinisekiswe ngabantu baseAsia kwiziphumo zophando kwixesha elizayo.