财新传媒
位置:博客 > 蔡晧东 > 怀孕妇女慎用丙硫氧嘧啶

怀孕妇女慎用丙硫氧嘧啶

  为了参加药监局有关丙硫氧嘧啶临床安全性的研讨会,我检索了国外有关丙硫氧嘧啶的药物不良反应。在检索过程中,我发现丙硫氧嘧啶对胎儿有一定的影响,因此写出博客,提醒怀孕妇女在孕期慎用丙硫氧嘧啶。
  丙硫氧嘧啶属于妊娠安全性D级的药物,它可以透过胎盘,也可以从乳汁中分泌,可能影响胎儿和新生儿的甲状腺功能。具国外医生研究,尽管丙硫氧嘧啶对胎儿的影响比甲亢平(卡比马唑)小得多[1],但是仍有多篇妊娠妇女服用丙硫氧嘧啶导致新生儿先天性甲状腺功能异常、甲状腺发育不全和甲状腺肿的报道[2-5]。另外还有引起胎儿先天性表皮发育不良[6]、肺血管发育异常[7]、胎儿水肿[8]等。因此,在丙硫氧嘧啶的药品说明书中也注明,“妊娠妇女慎用,哺乳期妇女禁用”。

  患有甲状腺功能亢进症的妇女应尽量在疾病得到控制,且不需要服药后再怀孕;在怀孕期间若需要治疗,应慎用丙硫氧嘧啶;产后哺乳期妇女如因疾病需要服用丙硫氧嘧啶治疗,则须停止哺乳,改用人工喂养。

 

References

[1] Bowman P, Vaidya B. Suspected Spontaneous Reports of Birth Defects in the UK Associated with the Use  of Carbimazole and Propylthiouracil in Pregnancy. J Thyroid Res. 2011. 2011: 235130.
[2] Yatsuga S, Hiromatsu Y, Sasaki S, et al. A two-day-old hyperthyroid neonate with thyroid hormone resistance born to a mother with well-controlled Graves' disease: a case report. J Med Case Rep. 2012. 6(1): 246.
[3] Almarzouki AA. Thyroid aplasia in male sibling of heterozygotic twins born to the hyperthyroid mother treated with propylthiouracil during pregnancy (case report). Endocr Regul. 2012. 46(1): 27-30.
[4] Yoshihara A, Noh J, Yamaguchi T, et al. Treatment of graves' disease with antithyroid drugs in the first trimester of pregnancy and the prevalence of congenital malformation. J Clin Endocrinol Metab. 2012. 97(7): 2396-403.
[5] Naggara C, Bos-Thompson MA, Mesnage R, et al. Monitoring of a baby with neonatal hypothyroidism after maternal exposure to propylthiouracil. Therapie. 2010. 65(6): 571-3.
[6] Lollgen RM, Calza AM, Schwitzgebel VM, Pfister RE. Aplasia cutis congenita in surviving co-twin after propylthiouracil exposure in utero. J Pediatr Endocrinol Metab. 2011. 24(3-4): 215-8.
[7] Vinocur JM, Sivanandam S. Fetal goiter mimicking anomalous pulmonary venous connection. Congenit Heart Dis. 2010. 5(5): 482-5.
[8] Yanai N, Shveiky D. Fetal hydrops, associated with maternal propylthiouracil exposure, reversed by intrauterine therapy. Ultrasound Obstet Gynecol. 2004. 23(2): 198-201.


 

了解抗疫现场,参看财新“万博汇”:

推荐 0