N\u0117\u0161tumas \u2013 unikali moters fiziologin\u0117 b\u016bsena, kurios metu gali pasireik\u0161ti nauji ar pa\u016bm\u0117ti esami miego sutrikimai. Su n\u0117\u0161tumu susij\u0119 veiksniai, galintys sutrikdyti mieg\u0105, yra r\u0117muo, naktinis oksitocino i\u0161siskyrimas, nikturija ir vaisiaus jud\u0117jimas. Da\u017eniausi miego sutrikimai n\u0117\u0161\u010diosioms yra nemiga (pirmin\u0117 ir antrin\u0117), nerami\u0173 koj\u0173 sindromas (NKS) ir narkolepsija\u00a0[1].<\/p>\n
\u00a0<\/p>\n
Pirmin\u0117 ir antrin\u0117 nemiga<\/b><\/p>\n
\u00a0<\/b><\/p>\n
Miego trukm\u0117 da\u017enai trump\u0117ja v\u0117lesn\u0117se n\u0117\u0161tumo faz\u0117se [2]. Da\u017enai su trumpesne miego trukme yra siejami \u0161ie veiksniai: pirmasis n\u0117\u0161tumas, jaunesnis ir vyresnis motinos am\u017eius, padid\u0117j\u0119s kraujo spaudimas\u00a0[3]. Ilgai trunkantys miego sutrikimai n\u0117\u0161\u010diosioms ir pagimd\u017eiusioms moterims didina nauj\u0173 ar pasikartojan\u010di\u0173 nuotaikos sutrikim\u0173 rizik\u0105, yra siejami su pailg\u0117jusia gimdymo trukme, didesne prie\u0161laikinio gimdymo rizika bei didina cezario pj\u016bvio atlikimo pirmagimio besilaukian\u010dioms n\u0117\u0161\u010dioms moterims tikimyb\u0119\u00a0[4\u20136]. Pirmin\u0117s nemigos gydymo strategijos apima kognityvin\u0119 elgesio terapij\u0105 ir farmakologin\u012f gydym\u0105, o antrin\u0117s\u00a0\u2013 psichini\u0173 ir (arba) medicinini\u0173 sutrikim\u0173 gydym\u0105 [1].<\/p>\n
\u00a0<\/p>\n
NKS<\/b><\/p>\n
\u00a0<\/b><\/p>\n
NKS sergantys pacientai skund\u017eiasi nemaloniu poj\u016b\u010diu, kuris kelia did\u017eiul\u012f nor\u0105 judinti kojas. \u0160is noras paprastai sustipr\u0117ja nakt\u012f ir ilsintis. NKS nustatomas daugiau nei ketvirtadaliui n\u0117\u0161\u010di\u0173 moter\u0173. Beveik dviem tre\u010ddaliams moter\u0173 anks\u010diau (iki n\u0117\u0161tumo) \u0161ie simptomai nebuvo pasirei\u0161k\u0119\u00a0[7\u20139]. Daugeliui moter\u0173 NKS i\u0161nyksta po gimdymo [10]. NKS yra susij\u0119s su dopamino metabolizmo disfunkcija centrin\u0117je nerv\u0173 sistemoje, kuri\u0105 n\u0117\u0161tumo metu gali sukelti gele\u017eies tr\u016bkumas serume (d\u0117l padid\u0117jusio gele\u017eies poreikio), folio r\u016bg\u0161ties tr\u016bkumas ir hormon\u0173, toki\u0173 kaip estradiolis, poveikis [1,\u00a08,\u00a011,\u00a012]. NKS gydymo strategijos apima farmakologin\u012f gydym\u0105 ir \u017einom\u0173 suk\u0117l\u0117j\u0173, toki\u0173 kaip kofeinas, r\u016bkymas ir tam tikri vaistai, pa\u0161alinim\u0105\u00a0[1].<\/p>\n
\u00a0<\/p>\n
Narkolepsija<\/b><\/p>\n
\u00a0<\/b><\/p>\n
Narkolepsija\u00a0\u2013 tai klinikinis sindromas, kuriam b\u016bdingas mieguistumas dien\u0105, pasirei\u0161kiantis d\u0117l nefunkcionalaus per\u0117jimo tarp miego stadij\u0173, da\u017enai lydimas katapleksijos, hipnagogini\u0173 haliucinacij\u0173 ir miego paraly\u017eiaus [13]. Pasteb\u0117ta, kad iki n\u0117\u0161tumo buvusi narkolepsija neretai pablog\u0117ja pastojus [1,\u00a014]. N\u0117\u0161\u010dios moterys, sergan\u010dios narkolepsija, turi didesn\u0119 anemijos ir gliukoz\u0117s toleravimo sutrikimo i\u0161sivystymo rizik\u0105, nors reik\u0161ming\u0173 vidutinio naujagimi\u0173 svorio ir gestacinio am\u017eiaus poky\u010di\u0173 gimimo metu n\u0117ra nustatyta, ta\u010diau i\u0161tirta, kad gimdymas gali paskatinti katapleksij\u0105 [1, 14].<\/p>\n
\u00a0<\/p>\n
Mieg\u0105 gerinan\u010di\u0173 vaist\u0173 skyrimas n\u0117\u0161\u010diosioms <\/b><\/p>\n
\u00a0<\/b><\/p>\n
N\u0117\u0161\u010diosioms pasirei\u0161kusi\u0173 miego sutrikim\u0173 gydymo tikslai yra skatinti atkuriam\u0105j\u012f mieg\u0105 ir atkurti jo teikiam\u0105 naud\u0105 tiek motinai, tiek vaisiui. Vaisiui \u012ftak\u0105 daro bet kokie motinos n\u0117\u0161tumo metu vartojami vaistai. Skiriant bet kok\u012f medikament\u0105 miego kokybei pagerinti n\u0117\u0161tumo metu, b\u016btina atsi\u017evelgti \u012f \u0161io vaisto rizik\u0105 bei naud\u0105 motinai ir vaisiui [15]. Toliau aptariami farmakologiniai preparatai ir j\u0173 poveikis perinataliniu laikotarpiu, atsi\u017evelgiant \u012f miego sutrikimus, kuriems jie skirti gydyti.<\/p>\n
\u00a0<\/p>\n
Pirmin\u0117s ir antrin\u0117s nemigos gydymas<\/b><\/p>\n
\u00a0<\/b><\/p>\n
Benzodiazepinai. <\/b>Benzodiazepinai veikia limbin\u012f, gumburo, pagumburio centrin\u0117s nerv\u0173 sistemos lygius ir didina gama\u00a0aminosviesto r\u016bg\u0161ties (GABA) neurotransmisij\u0105. Jie veikia per moduliacin\u0119 GABAA receptori\u0173 komplekso viet\u0105 ir sukelia raminam\u0105j\u012f, anksiolitin\u012f, antiepilepsin\u012f poveik\u012f. Benzodiazepinai da\u017eniausiai naudojami nemigai, nerimui ir traukuliams gydyti\u00a0[16, 17]. Nors \u0161ie medikamentai tinkamesni trumpalaikiam nemigos ir nerimo gydymui, ta\u010diau yra nema\u017eai pacient\u0173, vartojan\u010di\u0173 juos ilg\u0105 laik\u0105. Nustatyta, kad tai yra susij\u0119 su didele priklausomyb\u0117s, abstinencijos, mieguistumo, pa\u017eintini\u0173 funkcij\u0173 sutrikimo, griuvim\u0173 ir l\u016b\u017ei\u0173 rizika [18, 19]. Benzodiazepinai lengvai pereina placent\u0105 ir patenka \u012f vaisiaus audinius, ta\u010diau tyrimai rodo, kad benzodiazepinai n\u0117ra teratogeni\u0161ki [21, 22]. Ankstyvieji atvejo ir kontrol\u0117s tyrimai parod\u0117 padid\u0117jus\u012f l\u016bpos ar gomurio nesuaugimo da\u017en\u012f vartojant benzodiazepinus, ta\u010diau \u0161ios i\u0161vados nebuvo patvirtintos v\u0117lesniuose tyrimuose [21, 23\u201327]. Vis d\u0117lto yra \u012frodym\u0173, kad benzodiazepinai gali padidinti prie\u0161laikinio gimimo ir ma\u017eesnio gimdymo svorio rizik\u0105 [28].<\/p>\n
Hipnotiniai benzodiazepino receptori\u0173 agonistai.<\/b> Vaistams, priklausantiems hipnotini\u0173 benzodiazepino receptori\u0173 agonist\u0173 (HBRA) klasei, dar vadinamiems Z vaistais, priskiriamas imidazopiridino zolpidemas, pirazolo ir pirimidino zaleplonas, ciklopirolonai, zopiklonas ir eszopiklonas. HBRA\u00a0\u2013 \u0161iuo metu pasaulyje da\u017eniausiai skiriami migdomieji vaistai, \u012fskaitant ir n\u0117\u0161\u010dias moteris. Nors chemi\u0161kai nesusij\u0119 su benzodiazepinais, jie yra GABAA receptori\u0173 agonistai, trumpinantys u\u017emigimo laik\u0105, gerinantys miego kokyb\u0119. Manoma, kad jie tik minimaliai sutrikdo miego architekt\u016br\u0105 [29,\u00a030]. Da\u017eniausi su \u0161ios grup\u0117s vaistais siejami nepageidaujami rei\u0161kiniai yra atminties sutrikimai, nuovargis dien\u0105, haliucinacijos, fiziologin\u0117 priklausomyb\u0117 ir kt. [31,\u00a032]. HBRA, kaip ir benzodiazepinai, pereina placentos barjer\u0105 [33,\u00a034]. Teigiama, kad HBRA, vartojami \u012fprastomis terapin\u0117mis doz\u0117mis, nedidina \u012fgimt\u0173j\u0173 apsigimim\u0173 rizikos [28,\u00a034\u201337]. Vis d\u0117lto yra i\u0161tirtas atvejis, kai vartojant dideles zolpidemo dozes pirm\u0105j\u012f n\u0117\u0161tumo trimestr\u0105, i\u0161sivyst\u0117 nervinio vamzdelio defektai [38]. Nustatyta, kad HBRA gali padidinti prie\u0161laikinio gimimo tikimyb\u0119, yra susij\u0119 su ma\u017eesnio gimimo svorio naujagimiais. Tiesa, \u0161ie duomenys buvo nustatyti nedidel\u0117s imties tyrimuose [34, 39].<\/p>\n
Antidepresantai.<\/b> Manoma, kad, nepriklausomai nuo klas\u0117s, visi \u0161iuo metu rinkoje esantys antidepresantai veikia moduliuodami monoamino neurotransmiterius, serotonin\u0105, norepinefrin\u0105, dopamin\u0105 ir taip gydo depresij\u0105 bei nerim\u0105. D\u0117l kai kuri\u0173 antidepresant\u0173 sedacinio poveikio \u0161ios grup\u0117s vaistai neretai skiriami nemigai gydyti n\u0117\u0161tumo metu. Da\u017eniausiai skiriami tricikliai antidepresantai (TCA), piperazinoazepinas (mirtazapinas), serotonino-2 receptori\u0173 antagonistai ir serotonino reabsorbcijos inhibitorius, trazodonas [40]. Doksepinas ir amitriptilinas yra TCA, kurie ma\u017eomis doz\u0117mis da\u017eniausiai naudojami sutrikus miegui. Manoma, kad j\u0173 hipnotinis poveikis yra susij\u0119s su j\u0173 antihistaminergin\u0117mis savyb\u0117mis. TCA nepageidaujami rei\u0161kiniai yra sumi\u0161imas, viduri\u0173 u\u017ekiet\u0117jimas, sutrikusi rega, svorio priaugimas, tachikardija, \u0161irdies aritmijos, o perdozavus\u00a0\u2013 mirtis. Suaugusieji paprastai gerai toleruoja ma\u017e\u0105 doksepino doz\u0119, skiriam\u0105 nemigai gydyti [41]. Medikai, gydantys depresij\u0105 kartu su nemiga ir blogu apetitu, da\u017enai naudojasi pagrindiniais nepageidaujamais mirtazapino rei\u0161kiniais\u00a0\u2013 mieguistumu, apetito ir svorio didinimu [42]. Trazodonas, kuris i\u0161 prad\u017ei\u0173 buvo sukurtas kaip antidepresantas, dabar beveik i\u0161imtinai naudojamas nemigai gydyti. Da\u017eniausiai jis yra gerai toleruojamas, gerina miego kokyb\u0119 ir sutrumpina u\u017emigimo laik\u0105 [43, 44].<\/p>\n
\u00a0<\/p>\n
Tyrimuose nepasteb\u0117ta ry\u0161io tarp antidepresant\u0173 vartojimo perinataliniu laikotarpiu ir padid\u0117jusios \u012fgimt\u0173j\u0173 apsigimim\u0173 rizikos [45,\u00a046]. Nustatyta \u0161iek tiek padid\u0117jusi ma\u017eo svorio naujagimio ir prie\u0161laikinio gimdymo tikimyb\u0117, ta\u010diau tyrim\u0173 rezultatus gal\u0117jo paveikti pagrindin\u0117 liga [46,\u00a047]. Tyrim\u0173 duomenimis, vartojant antidepresantus v\u0117lyvuoju n\u0117\u0161tumo laikotarpiu, nedaug padid\u0117ja kv\u0117pavimo tak\u0173 simptom\u0173, \u012fskaitant nuolatin\u0119 naujagimio plautin\u0119 hipertenzij\u0105, rizika, ta\u010diau absoliuti rizika yra labai ma\u017ea [46, 48]. Sistemin\u0117je mirtazapino vartojimo n\u0117\u0161\u010dioms moterims ap\u017evalgoje nustatyta, kad gali padid\u0117ti savaiminio aborto rizika, ta\u010diau \u0161ie rezultatai gal\u0117jo b\u016bti susij\u0119 su pagrindine liga. Nebuvo nustatyta jokio ry\u0161io tarp prenatalinio mirtazapino vartojimo ir \u012fgimt\u0173j\u0173 apsigimim\u0173 [49].<\/p>\n
Antidepresant\u0173 vartojimas n\u0117\u0161tumo metu siejamas su neigiamu neurofiziologiniu poveikiu naujagimiams (dirglumu, drebuliu, nervingumu, miego sutrikimais), \u017einomu kaip naujagimi\u0173 adaptacijos sindromas, ta\u010diau \u0161ie simptomai paprastai b\u016bna trumpalaikiai [51, 52]. Pasteb\u0117tas papildomas neurologinis poveikis naujagimiams\u00a0\u2013 ne\u012fprasti bendrieji judesiai, ta\u010diau \u0161iuos rezultatus reikia vertinti itin atsargiai, nes daugelio t\u0173 pa\u010di\u0173 tyrim\u0173 metu motinoms buvo pasirei\u0161kusi ir negydoma depresija [51, 53].<\/p>\n
Antipsichoziniai vaistai.<\/b> Antipsichoziniai vaistai pirmiausia veikia kaip dopamino receptori\u0173 antagonistai. Pirmosios kartos antipsichoziniai vaistai (pasi\u017eymintys D2<\/sub> receptori\u0173 slopinimu) veikia i\u0161 esm\u0117s vienodai (skiriasi stiprumas). Antros kartos antipsichoziniai vaistai neturi tokio vienodo poveikio ir pasi\u017eymi serotonino receptorius slopinan\u010diu poveikiu. Antipsichozini\u0173 vaist\u0173 vartojimas nemigai gydyti tapo da\u017enu rei\u0161kiniu, ta\u010diau d\u0117l nepageidaujam\u0173 rei\u0161kini\u0173 n\u0117\u0161\u010diosios netur\u0117t\u0173 j\u0173 vartoti (jei pagrindin\u0117 indikacija yra nemiga). Daugelio antipsichozini\u0173 vaist\u0173 raminamasis poveikis gali b\u016bti naudingas gydant psichoz\u0119 ir nuotaikos sutrikimus. Sedaciniu poveikiu pasi\u017eymintys antros kartos antipsichoziniai vaistai yra klozapinas, olanzapinas, kvetiapinas ir risperidonas. Olanzapinas ir klozapinas d\u0117l skirtingo prisijungimo prie baltym\u0173 lygio prasiskverbia pro placent\u0105 grei\u010diau nei kvetiapinas ir risperidonas. In vivo<\/i> atlikt\u0173 tyrim\u0173 metu nustatyta, kad antipsichozini\u0173 vaist\u0173 koncentracija motinos kraujyje suma\u017e\u0117ja tre\u010di\u0105j\u012f n\u0117\u0161tumo trimestr\u0105 [54].<\/p>\n Naujausi antros kartos antipsichozini\u0173 vaist\u0173 tyrimai \u012frod\u0117, kad \u0161iuos vaistus galima vartoti perinataliniu laikotarpiu. Nenustatyta jokio ry\u0161io su \u012fgimtaisiais apsigimimais ar gestaciniu diabetu [55\u201357]. S\u00f8rensen ir koleg\u0173 atliktame tyrime nenustatyta, kad n\u0117\u0161\u010dioms moterims, kurios vartojo ir v\u0117liau nutrauk\u0117 antipsichotini\u0173 vaist\u0173 vartojim\u0105, padid\u0117t\u0173 spontaninio aborto i\u0161sivystymo rizika, ta\u010diau tai buvo susij\u0119 su negyvagimi\u0173 rizikos padid\u0117jimu (1,2\u00a0proc., palyginti su 0,6\u00a0proc.) [58]. JAV federalin\u0117 vaist\u0173 administracija 2011 metais paskelb\u0117 \u012fsp\u0117jim\u0105 apie \u0161i\u0105 vaist\u0173 klas\u0119 d\u0117l sukeliam\u0173 abstinencijos ir ekstrapiramidini\u0173 simptom\u0173 naujagimiams [59].<\/p>\n Melatoninas ir melatonino receptori\u0173 agonistai.<\/b> Melatoninas yra nat\u016braliai i\u0161siskiriantis neurotransmiteris, moduliuojantis vis\u0173 \u017einduoli\u0173 cirkadin\u012f ritm\u0105. \u017dinoma, kad n\u0117\u0161tumo metu melatoninas daro \u012ftak\u0105 vaisiaus lytiniam brendimui ir padid\u0117jusiai endogeninio melatonino sekrecijai [60]. Melatoninas taip pat gaminamas ir placentoje. Jis apsaugo nuo molekulini\u0173 pa\u017eeidim\u0173 bei l\u0105steli\u0173 disfunkcijos, i\u0161sivystan\u010dios d\u0117l oksidacinio streso [61]. Apie egzogeninio melatonino vartojim\u0105 n\u0117\u0161tumo metu yra nedaug duomen\u0173. Tyrimai, analizuojantys melatonino poveik\u012f naujagimiams, yra atlikti su pel\u0117mis. J\u0173 rezultatai prie\u0161taringi. Kai kurie rodo, kad melatoninas veikia neuroprotekci\u0161kai esant toksin\u0173 poveikiui, kiti rodo reprodukcini\u0173 hormon\u0173 sekrecijos ir cirkadinio ritmo po gimdymo sutrikim\u0105 [62\u201364].<\/p>\n Antihistamininiai vaistai. <\/b>Difenhidraminas ir hidroksizinas yra pla\u010diai vartojami n\u0117\u0161tumo metu, ta\u010diau atlikta nedaug \u0161i\u0173 vaist\u0173 saugumo profilio \u017emon\u0117ms tyrim\u0173. Khazaie ir koleg\u0173 tyrimas \u012fvertino nemigos gydymo antihistamininiais vaistais tre\u010diojo n\u0117\u0161tumo trimestro metu poveik\u012f miegui ir depresijos po gimdymo simptomams. \u0160iame tyrime dalyvavo 54 n\u0117\u0161\u010diosios, kurioms atsitiktine tvarka buvo paskirta trazodono 50\u00a0mg\/p., difenhidramino 25\u00a0mg\/d. arba gydymas placebu [50]. Trazodonas ir difenhidraminas labai pagerino miego trukm\u0119, miego efektyvum\u0105, palyginti su placebu. Abu vaistai suma\u017eino depresijos simptomus. Doksilamino yra daugelyje nereceptini\u0173 miego gerinimo priemoni\u0173.<\/p>\n Einarsonas su kolegomis palygino 53 n\u0117\u0161\u010dias moteris, vartojan\u010dias hidroksizin\u0105, su 23 moterimis, vartojan\u010diomis cetirizin\u0105, ir kontroline grupe, ta\u010diau nenustat\u0117 reik\u0161ming\u0173 skirtum\u0173 tarp savaiminio, terapinio abort\u0173 ar negyvagimi\u0173 gimimo rizikos [65]. 2005 metais buvo prane\u0161ta apie naujagimio abstinencijos sindromo pasirei\u0161kimo atvej\u012f, siejam\u0105 su hidroksizino vartojimu (150\u00a0mg\/d.) [66]. Izraelio teratogenini\u0173 veiksni\u0173 informacijos tarnyba steb\u0117jo 37 n\u0117\u0161\u010di\u0105sias, vartojan\u010dias hidroksizin\u0105, ir nenustat\u0117 padid\u0117jusios \u012fgimt\u0173j\u0173 apsigimim\u0173 rizikos [67]. Li ir koleg\u0173 atliktame tyrimas nenustatyta reik\u0161ming\u0173 difenhidramino ir doksilamino s\u0105saj\u0173 su \u012fgimtaisiais apsigimimais [68]. Kitas tyrimas nustat\u0117 galim\u0105 difenhidramino, doksilamino ir apsigimim\u0173 ry\u0161\u012f, ta\u010diau buvo sukritikuotas d\u0117l \u0161ali\u0161kumo ir santykinai ma\u017eos imties [70].<\/p>\n \u00a0<\/p>\n NKS gydymas<\/b><\/p>\n \u00a0<\/p>\n Dopamino agonistai.<\/b> Dopamino agonistai, \u012fskaitant pramipeksol\u012f, ropinirol\u012f ir rotigotin\u0105, yra laikomi pirmojo pasirinkimo vaistais gydant NKS nesilaukian\u010dioms moterims ir suaugusiems pacientams. Karbidopa-levodopa gali b\u016bti naudojamas NKS simptomams mal\u0161inti, tais atvejais, kai simptomai pasirei\u0161kia su pertraukomis vakarais, prie\u0161 mieg\u0105, prabudus nakt\u012f arba yra susij\u0119 su specifine veikla, pavyzd\u017eiui, ilgai trunkan\u010diu va\u017eiavimu automobiliu [71]. Dopamino agonistai, tokie kaip bromokriptinas, kabergolinas ir pergolidas netur\u0117t\u0173 b\u016bti naudojami NKS gydyti, nes jie siejami su \u0161irdies vo\u017etuv\u0173 fibroze ir kitomis fibrozin\u0117mis reakcijomis [72, 73]. Da\u017eniausi dopamino agonist\u0173 nepageidaujami rei\u0161kiniai yra pykinimas ir galvos svaigimas (kurie paprastai i\u0161nyksta per 10\u201314 dien\u0173), re\u010diau\u00a0\u2013 nosies u\u017egulimas, viduri\u0173 u\u017ekiet\u0117jimas, nemiga ir koj\u0173 edema (gr\u012f\u017etami, nutraukus gydym\u0105). Vartojant didesnes dozes, gali i\u0161sivystyti hipersomnija\u00a0[71]. Gydym\u0105 ribojan\u010dios nepageidaujamos reakcijos\u00a0\u2013 NKS simptom\u0173 pablog\u0117jimas anks\u010diau dien\u0105, po vakarin\u0117s vaist\u0173 doz\u0117s, impuls\u0173 kontrol\u0117s sutrikimai ir kt.\u00a0[74, 75].<\/p>\n Literat\u016bros apie farmakologin\u012f NKS gydym\u0105 n\u0117\u0161tumo metu yra nedaug, tod\u0117l buvo suburta 9 ekspert\u0173 tarptautin\u0117 darbo grup\u0117, kurios tikslas parengti NKS diagnozavimo ir gydymo n\u0117\u0161tumo ir \u017eindymo metu gaires [76]. \u0160i ekspert\u0173 grup\u0117 2015 metais pateik\u0117 perinatalinio NKS nefarmakologinio (gele\u017eies papildymo) ir farmakologinio gydymo rekomendacijas. Kaip ir kalbant apie kitus vaistus, darbo grup\u0117 reikalavo \u012fvertinti dopamino agonist\u0173 vartojimo gydant NKS n\u0117\u0161tumo metu rizikos ir naudos santyk\u012f [76]. Nors yra daugiau \u012frodym\u0173 apie neskalsi\u0173 dopamino agonist\u0173 veiksmingum\u0105 gydant NKS, palyginti su karbidopa-levodopa, ta\u010diau daugiau saugumo duomen\u0173 yra apie karbidopa-levodopa vartojim\u0105 n\u0117\u0161tumo metu [76]. Registruoti 38 karbidopa-levodopos vartojimo mal\u0161inant NKS simptomus n\u0117\u0161tumo metu atvejai ir didel\u0117s malformacijos ar kiti nepageidaujami rei\u0161kiniai nebuvo nustatyti [77]. D\u0117l galimo neigiamo poveikio kaul\u0173 vystymuisi der\u0117t\u0173 vengti levodopos ir benserazido derinio [76]. Kadangi duomen\u0173 apie neskalsi\u0173 dopamino agonist\u0173 saugum\u0105 n\u0117\u0161tumo metu yra nedaug, ekspert\u0173 darbo grup\u0117 \u012fvertino \u0161iuos vaistus kaip turin\u010dius nepakankamai \u012frodym\u0173, kad b\u016bt\u0173 galima priimti sprendim\u0105 [76]. Darbo grup\u0117s rekomendacijose nurodyta vengti skalsi\u0173 dopamino agonist\u0173 NKS n\u0117\u0161tumo metu gydyti, atsi\u017evelgiant \u012f j\u0173 fibrozini\u0173 reakcij\u0173 potencial\u0105 [76, 78].<\/p>\n \u00a0<\/p>\n Narkolepsijos gydymas<\/b><\/p>\n \u00a0<\/p>\n Stimuliantai. <\/b>Nors stimuliantai naudojami perinataliniams miego sutrikimams gydyti, ta\u010diau jie nebuvo sistemingai i\u0161tirti. Danijoje atliktame tyrime, kuriame dalyvavo 480 moter\u0173, n\u0117\u0161tumo metu vartojusi\u0173 metilfenidat\u0105, modafinil\u0105 ar atomoksetin\u0105, nustatyta dvigubai didesn\u0117 sukelt\u0173 abort\u0173 ir persileidim\u0173 rizika, ta\u010diau rezultatus grei\u010diausiai paveik\u0117 kitos indikacijos [81]. Daugiacentriame perspektyviajame tyrime, kuriame dalyvavo 382 moterys, vartojusios metilfenidat\u0105 n\u0117\u0161tumo metu, taip pat buvo nustatyti pana\u0161\u016bs rezultatai. Manoma, kad juos taip pat gal\u0117jo paveikti kitos ligos [82]. Nebuvo nustatyta s\u0105saj\u0173 tarp \u012fgimt\u0173j\u0173 patologij\u0173 ar \u0161irdies ir kraujagysli\u0173 sistemos defekt\u0173, susijusi\u0173 perinataliniu metilfenidato naudojimu [82].<\/p>\n \u017dadinim\u0105 skatinan\u010dios med\u017eiagos.<\/b> Retrospektyviajame atvejo ir kontrol\u0117s tyrime, kuriame tirtos 25 moterys, sergan\u010dios narkolepsija ir katapleksija, analizuotas modafinilo ir metilfenidato poveikis n\u0117\u0161tumo baigtims. Reik\u0161mingo skirtumo, palyginti su kontroline grupe, nenustatyta [84, 85]. Armodafinilo vartojimo n\u0117\u0161tumo metu tyrim\u0173 neatlikta.<\/p>\n Natrio oksibatas, gama hidroksibutiratas ir kiti. <\/b>N\u0117ra atlikto tyrimo su \u017emon\u0117mis, \u012fvertinan\u010dio natrio oksibato ar gama hidroksibutirato vartojimo poveik\u012f n\u0117\u0161\u010diosioms. Narkolepsijai gydyti pacientams (i\u0161skyrus besilaukian\u010dias moteris) vartojami opioidai, karbamazepinas, valproin\u0117 r\u016bg\u0161tis, klonidinas, gabapentinas, pregabalinas, bromokriptinas ir kabergolinas [1]. I\u0161 j\u0173 opioidai n\u0117ra pirmojo pasirinkimo ir netur\u0117t\u0173 b\u016bti skiriami n\u0117\u0161\u010diosioms. D\u0117l \u017einomo teratogeni\u0161kumo valproin\u0117s r\u016bg\u0161ties ir karbamazepino n\u0117\u0161tumo metu vartoti negalima. Gabapentino ir pregabalino tyrimai apsiriboja traukuliais, kaip indikacija, o ne narkolepsija. Bromokriptinas ir kabergolinas nerekomenduojami vartoti n\u0117\u0161tumo metu [1].<\/p>\n \u00a0<\/p>\n Apibendrinimas<\/b><\/p>\n \u00a0<\/b><\/p>\n Miego sutrikimai, tokie kaip pirmin\u0117 ir antrin\u0117 nemiga, NKS, narkolepsija da\u017enai pasirei\u0161kia ar sustipr\u0117ja n\u0117\u0161tumo metu [1]. Mokslin\u0117s literat\u016bros apie vaist\u0173, gydan\u010di\u0173 miego sutrikimus, poveik\u012f n\u0117\u0161tumo metu da\u017enai b\u016bna ma\u017eai arba net neb\u016bna, tod\u0117l prie\u0161 paskiriant farmakologin\u012f miego sutrikim\u0173 gydym\u0105 reikia \u012fvertinti individualizuot\u0105 galimos negydomos ligos poveik\u012f, padarinius tiek motinai, tiek k\u016bdikiui ir visa tai palyginti su farmakologinio poveikio nauda ir rizika [15].<\/p>\n STRAIPSNIO AUTOR\u0116 \u2013\u00a0<\/strong>Andra Ker\u0161evi\u010di\u016bt\u0117,\u00a0Lietuvos sveikatos moksl\u0173 universitetas<\/b><\/p>\n Parengta pagal McLafferty LP, Spada M, Gopalan P. Pharmacologic Treatment of Sleep Disorders in Pregnancy. Sleep Med Clin. 2018;13:243\u2013250.<\/i><\/b><\/p>\n Literat\u016bra<\/b><\/p>\n 1. Oyiengo D, et al. Sleep disorders in pregnancy. Clin Chest Med 2014;35:571\u201387. N\u0117\u0161tumas \u2013 unikali moters fiziologin\u0117 b\u016bsena, kurios metu gali pasireik\u0161ti nauji ar pa\u016bm\u0117ti esami miego sutrikimai. Su n\u0117\u0161tumu susij\u0119 veiksniai, galintys sutrikdyti mieg\u0105, yra r\u0117muo, naktinis oksitocino i\u0161siskyrimas, nikturija ir vaisiaus jud\u0117jimas. Da\u017eniausi miego sutrikimai n\u0117\u0161\u010diosioms yra nemiga (pirmin\u0117 ir antrin\u0117), nerami\u0173 koj\u0173 sindromas (NKS) ir narkolepsija.<\/p>\n","protected":false},"author":1,"featured_media":110,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27322],"tags":[24505,1240,26841,26833,26834,26252,26827,26820,26256,26818,26297,571,26845,26812,26837,10802,26831,26840,26828,12756,26513,12752,26253,6035,26819,26249,411,26832,26817,26808,5377,26805,40,26816,8401,10794,3543,26822,26811,26251,26813,4995,1477,26829,26669,10859,26824,26248,26844,26842,26836,26375,26830,26807,26835,26826,26679,26825,15211,26821,26298,26815,26814,26267,26810,26843,125,10760,26839,21,26804,26806,10837,26838,8568,26809,20934,138,26823,21286],"site":[],"post_item_type":[28490],"class_list":["post-109","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ligu-gydymas","tag-proc","tag-antidepresantai","tag-antipsichoziniai-vaistai","tag-antipsychotic","tag-atypical","tag-birth","tag-citrin","tag-cleft","tag-cohort","tag-congenital","tag-defects","tag-diabetes","tag-diav-citrin","tag-disorder","tag-doiorg","tag-during","tag-einarson","tag-ekbom","tag-exposed","tag-exposure","tag-fetal","tag-general","tag-gestational","tag-gydymas","tag-gynaecol","tag-gynecol","tag-health","tag-huybrechts","tag-hypnotic","tag-insomnia","tag-kabergolinas","tag-khazaie","tag-kofeinas","tag-koren","tag-kvetiapinas","tag-lactation","tag-levodopa","tag-malformations","tag-manconi","tag-maternal","tag-narcolepsy","tag-narkolepsija","tag-nemiga","tag-neonatal","tag-neurol","tag-neurological","tag-newer","tag-obstet","tag-obstet-gynaecol","tag-obstet-gynecol","tag-offspring","tag-outcome","tag-pharmacoepidemiol","tag-pharmacologic","tag-pineal","tag-placental","tag-postpartum","tag-pract","tag-pramipexole","tag-prenatal","tag-preterm","tag-psychiatr","tag-psychopharmacol","tag-reprod","tag-restless","tag-restless-legs","tag-rukymas","tag-second","tag-silber","tag-sindromas","tag-sorensen","tag-stimuliantai","tag-teratogenic","tag-teratol","tag-trazodonas","tag-trimester","tag-updated","tag-vaistai","tag-wikner","tag-willis"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/109","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=109"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/109\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/110"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=109"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=109"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=109"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=109"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=109"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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