Article

Pregnancy, delivery, and outcome for the child in maternal epilepsy

Department of Clinical Medicine, Section for Neurology, University of Bergen, Norway.
Epilepsia (Impact Factor: 4.58). 06/2009; 50(9):2130-9. DOI: 10.1111/j.1528-1167.2009.02147.x
Source: PubMed

ABSTRACT To investigate pregnancy, delivery, and child outcome in an unselected population of women with both treated and untreated epilepsy.
In the compulsory Medical Birth Registry of Norway, all 2,861 deliveries by women with epilepsy recorded from 1999-2005 were compared to all 369,267 nonepilepsy deliveries in the same period.
The majority (66%, n = 1900) in the epilepsy group did not use antiepileptic drugs (AEDs) during pregnancy. A total of 961 epilepsy-pregnancies were exposed to AEDs. Compared to nonepilepsy controls, AED-exposed infants were more often preterm (p = 0.01), and more often had birth weight <2,500 g (p < 0.001), head circumference <2.5 percentile (p < 0.001), and low Apgar score (p = 0.03). Small-for-gestational-age (SGA) infants (<10 percentile) occurred more frequently in both AED-exposed (p = 0.05) and unexposed (p = 0.02) epilepsy-pregnancies. Frequency of major congenital malformations (MCMs) was 2.8% (n = 81) in the epilepsy group versus 2.5% in controls (p = 0.3). Increased risk for MCMs could be demonstrated only for exposure to valproate (5.6%, p = 0.005) and AED polytherapy (6.1%, p = 0.02). Neonatal spina bifida was not significantly increased, but was a major indication for elective pregnancy termination among women with epilepsy. Cesarean section was performed more often in maternal epilepsy, regardless of AED-exposure (p < 0.001).
Adverse pregnancy and birth outcome in women with epilepsy is mainly confined to AED-exposed pregnancies, although some risks are associated also with untreated epilepsy. The risk for congenital malformations was lower than previously reported. This could be due to a shift in AED selection, folic acid supplement, or possibly reflect the true risks in an unselected epilepsy population.

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    • "Indeed, epilepsy not requiring AEDs therapy is not the same disease as epilepsy requiring high doses of AEDs. Some of the previous studies comparing epileptic women undergoing AEDs therapy with untreated epileptic women assumed that the disease was identical in the two groups and any differences observed in pregnancy outcomes would be attributed to the treatment [10]. Furthermore, comparing two groups of women with different disorders (such as epilepsy on one side and psychiatric disorders and neuropathic pain on the other) using the same AEDs therapy could help to understand the different role of the disease and of the drugs. "
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    • "Indeed, epilepsy not requiring AEDs therapy is not the same disease as epilepsy requiring high doses of AEDs. Some of the previous studies comparing epileptic women undergoing AEDs therapy with untreated epileptic women assumed that the disease was identical in the two groups and any differences observed in pregnancy outcomes would be attributed to the treatment [10]. Furthermore, comparing two groups of women with different disorders (such as epilepsy on one side and psychiatric disorders and neuropathic pain on the other) using the same AEDs therapy could help to understand the different role of the disease and of the drugs. "
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    • "Indeed, epilepsy not requiring AEDs therapy is not the same disease as epilepsy requiring high doses of AEDs. Some of the previous studies comparing epileptic women undergoing AEDs therapy with untreated epileptic women assumed that the disease was identical in the two groups and any differences observed in pregnancy outcomes would be attributed to the treatment [10]. Furthermore, comparing two groups of women with different disorders (such as epilepsy on one side and psychiatric disorders and neuropathic pain on the other) using the same AEDs therapy could help to understand the different role of the disease and of the drugs. "
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    ABSTRACT: Infants born to epileptic women treated with Antiepileptic Drugs (AEDs) have an increased risk of major congenital malformations (MCMs). In order to determine the role of maternal epilepsy we conducted a prospective cohort study on three cohorts of pregnant women: i) 385 epileptic women treated with AEDs, ii) 310 non-epileptic women treated with AEDs, iii) 867 healthy women not exposed to AEDs (control group). The rate of MCMs in the epileptic group (7.7%) was not statistically higher than in the non-epileptic one (3.9%) (p=0.068). The rate in the first group was higher compared to the control group (p=0.001), while the rate in the second one was not (p=0.534). Our data confirm that AEDs therapy is the main cause of the increased risk of malformations in the offspring of epileptic women; however a teratogenic role of the maternal epilepsy itself cannot be excluded.
    Reproductive Toxicology 04/2013; 39. DOI:10.1016/j.reprotox.2013.04.002 · 2.77 Impact Factor
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