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Publication
Cardiopatias CongĂ©nitas: a InfluĂȘncia da Epilepsia Materna
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Abstract(s)
Introdução: As cardiopatias congénitas (CC) são as malformaçÔes congénitas mais
frequentes e uma das principais causas de mortalidade infantil associada a anomalias
estruturais e/ou funcionais. A epilepsia, uma condição neurológica comum em mulheres
em idade fértil, levanta preocupaçÔes durante a gravidez, tanto pelos efeitos das crises
epiléticas como pelos riscos teratogénicos dos antiepiléticos (AE).
Objetivos: Com esta dissertação, pretende-se avaliar a associação entre epilepsia
materna e o risco de desenvolvimento de CC no feto, quer pela relação fisiopatológica da
prĂłpria doença quer pelo efeito da terapĂȘutica de controlo instituĂda.
Metodologia: Realizou-se uma revisĂŁo bibliogrĂĄfica entre janeiro de 2024 e janeiro de
2025, obtidos através de bases de dados como PubMed, Google Scholar, Cochrane e
Dynamed, bem como documentos oficiais da Organização Mundial de SaĂșde (OMS) e da
Direção Geral de SaĂșde (DGS). Foram incluĂdos estudos dos Ășltimos 25 anos, dada a
escassez de publicaçÔes especĂficas.
Resultados: Verificou-se que a epilepsia materna estĂĄ associada a um aumento do risco
de CC, sobretudo em casos de mĂĄ adesĂŁo terapĂȘutica, epilepsia refratĂĄria, crises
generalizadas e uso de determinados AE, especialmente o valproato de sĂłdio (VPA). A
suplementação com åcido fólico demonstrou ter um papel protetor, mas é
frequentemente insuficiente. As CC mais frequentemente associadas foram defeitos
interventricular e interauricular, tetralogia de Fallot entre outras malformaçÔes
estruturais cardĂacas.
ConclusĂŁo: A epilepsia na gravidez deve ser abordada de forma multidisciplinar e
individualizada. A escolha adequada da terapĂȘutica, o planeamento prĂ©-concecional e a
correta educação da doente são cruciais para minimizar o risco de CC no feto, garantindo
a segurança materna e fetal durante a gestação e no pós-parto.
Introduction: Congenital heart defects (CHDs) are the most frequent congenital malformations and one of the leading causes of infant mortality associated with structural and/or functional abnormalities. Epilepsy, a common neurological condition among women of reproductive age, raises significant concerns during pregnancy due to both the effects of seizures and the teratogenic risks associated with antiepileptic drugs (AEDs). Objectives: This dissertation aims to assess the association between maternal epilepsy and the risk of fetal CHDs, considering both the pathophysiological mechanisms of the disease itself and the effects of the pharmacological treatment used for seizure control. Methods: A literature review was conducted between January 2024 and January 2025 using databases such as PubMed, Google Scholar, Cochrane and Dynamed, as well as official documents from the WHO and the Portuguese Directorate-General for Health. Due to the scarcity of specific publications, studies from the past 25 years were included. Results: Maternal epilepsy was found to be associated with an increased risk of CHDs, particularly in cases of poor therapeutic adherence, refractory epilepsy, generalized seizures, and the use of specific AEDs, especially sodium valproate. Folic acid supplementation demonstrated a protective role, although often insufficient. The most commonly associated CHDs included ventricular and atrial septal defects, tetralogy of Fallot, and other structural cardiac anomalies. Conclusion: Epilepsy during pregnancy requires a multidisciplinary and individualized approach. Appropriate therapeutic choices, preconception planning, and patient education are essential to minimizing the risk of CHDs in the fetus, ensuring maternal and fetal safety throughout pregnancy and the postpartum period.
Introduction: Congenital heart defects (CHDs) are the most frequent congenital malformations and one of the leading causes of infant mortality associated with structural and/or functional abnormalities. Epilepsy, a common neurological condition among women of reproductive age, raises significant concerns during pregnancy due to both the effects of seizures and the teratogenic risks associated with antiepileptic drugs (AEDs). Objectives: This dissertation aims to assess the association between maternal epilepsy and the risk of fetal CHDs, considering both the pathophysiological mechanisms of the disease itself and the effects of the pharmacological treatment used for seizure control. Methods: A literature review was conducted between January 2024 and January 2025 using databases such as PubMed, Google Scholar, Cochrane and Dynamed, as well as official documents from the WHO and the Portuguese Directorate-General for Health. Due to the scarcity of specific publications, studies from the past 25 years were included. Results: Maternal epilepsy was found to be associated with an increased risk of CHDs, particularly in cases of poor therapeutic adherence, refractory epilepsy, generalized seizures, and the use of specific AEDs, especially sodium valproate. Folic acid supplementation demonstrated a protective role, although often insufficient. The most commonly associated CHDs included ventricular and atrial septal defects, tetralogy of Fallot, and other structural cardiac anomalies. Conclusion: Epilepsy during pregnancy requires a multidisciplinary and individualized approach. Appropriate therapeutic choices, preconception planning, and patient education are essential to minimizing the risk of CHDs in the fetus, ensuring maternal and fetal safety throughout pregnancy and the postpartum period.
Description
Keywords
Antiepiléticos Cardiopatias Congénitas Epilepsia Gravidez Teratogenicidad