labarai

Ga matan da suka kai shekarun haihuwa tare da farfadiya, amincin magungunan rigakafin yana da matukar muhimmanci a gare su da kuma 'ya'yansu, saboda ana buƙatar magani sau da yawa a lokacin daukar ciki da kuma shayarwa don rage tasirin kamawa. Ko ci gaban gabobin tayi ya shafi maganin maganin maganin ciwon daji yayin daukar ciki yana da damuwa. Nazarin da suka gabata sun ba da shawarar cewa a cikin magungunan gargajiya na anti-seizure, valproic acid, phenobarbital, da carbamazepine na iya gabatar da haɗarin teratogenic. Daga cikin sabbin magungunan kashe kwayoyin cuta, ana daukar lamotrigine a matsayin mai lafiya ga tayin, yayin da topiramate na iya kara hadarin tsinkewar lebe da baki.

Yawancin bincike na ci gaba na neurodevelopmental sun nuna haɗin gwiwa tsakanin yin amfani da valproic acid na uwa a lokacin daukar ciki da kuma rage yawan aikin fahimi, autism, da rashin kulawa da hankali (ADHD) a cikin zuriya. Koyaya, ingantacciyar shaida akan alaƙar da ke tsakanin amfani da topiramate na uwa yayin daukar ciki da haɓakar neurodevelopment na zuriya ya kasance bai isa ba. Abin godiya, sabon binciken da aka buga a makon da ya gabata a cikin New England Journal of Medicine (NEJM) ya kawo mana ƙarin shaida

A cikin duniyar gaske, manyan gwaje-gwajen da bazuwar ba zai yiwu ba a cikin mata masu juna biyu masu fama da farfaɗiya waɗanda ke buƙatar magungunan kashe ƙarfi don bincika amincin magungunan. Sakamakon haka, rajistar masu juna biyu, nazarin ƙungiyoyi, da nazarin kula da shari'a sun zama ƙirar binciken da aka fi amfani da su. Ta hanyar mahangar hanya, wannan binciken yana ɗaya daga cikin ingantaccen karatun da za a iya aiwatarwa a halin yanzu. Babban abin da ya fi dacewa shi ne kamar haka: ana ɗaukar hanyar nazarin ƙungiyoyi masu girma na tushen yawan jama'a. Ko da yake ƙira ta koma baya, bayanan sun fito ne daga manyan bayanai na ƙasa guda biyu na tsarin Medicaid da Medicare waɗanda aka yi rajista a baya, don haka amincin bayanan yana da girma; Lokacin bin tsaka-tsaki shine shekaru 2, wanda a zahiri ya cika lokacin da ake buƙata don gano cutar Autism, kuma kusan 10% (fiye da 400,000 lokuta gabaɗaya) an bi su fiye da shekaru 8.

Binciken ya hada da mata masu juna biyu fiye da miliyan 4, 28,952 daga cikinsu sun kamu da cutar farfadiya. An tara mata bisa ga ko suna shan magungunan antiepileptic ko wasu magungunan antiepileptic daban-daban bayan makonni 19 na ciki (matakin da synapses ke ci gaba da samuwa). Topiramate yana cikin ƙungiyar da aka fallasa, valproic acid yana cikin ƙungiyar kulawa mai kyau, kuma lamotrigine yana cikin ƙungiyar kulawa mara kyau. Ƙungiyar da ba a bayyana ba ta haɗa da duk mata masu juna biyu waɗanda ba sa shan wani maganin hana kamuwa da cuta daga kwanaki 90 kafin lokacin haila na ƙarshe zuwa lokacin haihuwa (har da rashin aiki ko farfadiya).

Sakamakon ya nuna cewa kiyasin yawan abubuwan da suka faru na autism a cikin shekaru 8 shine 1.89% a cikin dukkanin zuriyar da ba a fallasa su ga kowane magungunan antiepileptic; Daga cikin 'ya'yan da aka haifa ga iyaye mata masu fama da ciwon ciki, yawan abubuwan da suka faru na autism sun kasance 4.21% (95% CI, 3.27-5.16) a cikin yara waɗanda ba su da magungunan antiepileptic. Yawan abubuwan da suka faru na autism a cikin 'ya'yan da aka fallasa su zuwa topiramate, valproate, ko lamotrigine shine 6.15% (95% CI, 2.98-9.13), 10.51% (95% CI, 6.78-14.24), da 4.08% (95% CI-5.7) girmamawa

Idan aka kwatanta da 'yan tayin da ba a fallasa su ga magungunan antiseizure, haɗarin autism da aka daidaita don ƙididdige ƙididdiga kamar haka: Ya kasance 0.96 (95% CI, 0.56 ~ 1.65) a cikin rukuni na topiramate, 2.67 (95% CI, 1.69 ~ 4.20) a cikin ƙungiyar valproic acid, da 9.6% ~ 0.9. a cikin rukuni na lamotrigine. A cikin bincike na rukuni, marubutan sun zana irin wannan ra'ayi dangane da ko marasa lafiya sun sami monotherapy, adadin maganin miyagun ƙwayoyi, da kuma ko akwai alamun bayyanar cututtuka a farkon ciki.

Sakamakon ya nuna cewa 'ya'yan mata masu juna biyu masu ciwon farfadiya suna da haɗarin autism (kashi 4.21). Topiramate ko lamotrigine ba su ƙara haɗarin Autism a cikin 'ya'yan uwaye da suka sha maganin hana daukar ciki a lokacin daukar ciki; Duk da haka, lokacin da aka dauki valproic acid a lokacin daukar ciki, an sami karuwar hadarin da ke dogara da kashi a cikin zuriya. Kodayake binciken ya mayar da hankali ne kawai akan abubuwan da suka faru na Autism a cikin 'ya'yan mata masu juna biyu da ke shan magungunan antiseizure, kuma bai rufe sauran sakamakon ci gaban neurodevelopmental na yau da kullun kamar raguwar fahimi a cikin zuriya da ADHD ba, har yanzu yana nuna ƙarancin ƙarancin neurotoxicity na topiramate a cikin zuriya idan aka kwatanta da valproate.

Topiramate gabaɗaya ba a la'akari da abin da zai iya maye gurbin sodium valproate a lokacin daukar ciki, saboda yana iya ƙara haɗarin fashewar lebe da faranta da ƙanana don shekarun haihuwa. Bugu da ƙari, akwai nazarin da ke nuna cewa topiramate na iya ƙara haɗarin rashin lafiyar neurodevelopmental a cikin zuriya. Duk da haka, binciken NEJM ya nuna cewa idan kawai la'akari da tasiri akan ci gaban neurodevelopment na zuriya, ga mata masu juna biyu da suke buƙatar amfani da valproate don maganin cututtuka, ya zama dole don ƙara haɗarin cututtuka na neurodevelopmental a cikin zuriya. Ana iya amfani da Topiramate azaman madadin magani. Ya kamata a lura cewa rabon mutanen Asiya da sauran tsibirin Pacific a cikin duka rukunin yana da ƙasa sosai, wanda ya kai kashi 1% na ƙungiyar gabaɗaya, kuma ana iya samun bambance-bambancen kabilanci a cikin mummunan halayen da ke tattare da magunguna, don haka ko za a iya ba da sakamakon wannan binciken kai tsaye ga mutanen Asiya (ciki har da Sinawa) yana buƙatar tabbatar da ƙarin sakamakon binciken Asiya na gaba.