Article

Pregnancy and perinatal outcome in epileptic women: a population-based study.

Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Be'er-Sheva, Israel.
Journal of Maternal-Fetal and Neonatal Medicine (impact factor: 1.5). 02/2006; 19(1):21-5. DOI:10.1080/14767050500434096 pp.21-5
Source: PubMed

ABSTRACT To investigate the pregnancy outcome of patients with epilepsy.
A population-based study comparing all singleton pregnancies of patients with and without epilepsy was performed. Patients lacking prenatal care were excluded from the analysis. Deliveries occurred between the years 1988 and 2002 in a tertiary medical center. Stratified analysis, using a multiple logistic regression model, was performed to control for confounders.
During the study period 139 168 singleton deliveries occurred in our medical center. Of these, 220 (0.2%) were of patients with epilepsy. With the exception of gestational diabetes mellitus (GDM), no other significant differences regarding maternal outcomes were noted between the groups. However, a higher rate of congenital malformations was noted among the epileptic population (7.7% vs. 3.8%; p < 0.001). Also, a higher rate of cesarean deliveries (CD) was found among epileptic women (17.3% vs. 11.55%, p = 0.008). This association was persistent after controlling for possible confounders, using a multivariable analysis (OR = 1.5, 95% CI 1.1-2.3; p = 0.05).
The course of pregnancy of patients with epilepsy is favorable, except for higher rates of cesarean deliveries, GDM, and congenital malformations.

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  • Article: Effects of Maternal Epilepsy and Antiepileptic Drug Use during Pregnancy on Perinatal Health in Offspring: Nationwide, Retrospective Cohort Study in Finland
    Artama M, Gissler M, Malm H, Ritvanen A
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    ABSTRACT: Abstract INTRODUCTION: Perinatal health outcomes other than major congenital anomalies in offspring of women with epilepsy (WWE) have not been widely studied, and results of previous studies are conflicting and are mostly based on small numbers. Antiepileptic drugs (AEDs) pass through the placenta and may affect neonatal outcome. METHODS: This register-based study is based on information on all pregnancies ending in birth in Finland between 1996 and 2008. The data were obtained from the Finnish national health registers with data linkages based on the unique personal identification numbers. Information on maternal epilepsy diagnosis, AED purchases and other background factors was obtained to evaluate data on perinatal and infant health for all singleton births (n = 751,139). Drug purchases were considered to be an indicator for drug use. The outcomes included mode of delivery (vaginal birth or Caesarean section), preterm birth, low birth weight, weight for gestational age, low Apgar score, need for respiratory treatment, admission to neonatal care unit, perinatal death and infant death. RESULTS: In total, 4,867 (0.6 %) infants (including live births and stillbirths) were exposed to maternal epilepsy. More than half of the offspring of WWE were exposed to AED (n = 3,067, 63.0 %) during pregnancy or 1 month prior to and/or during pregnancy, and mostly in monotherapy (n = 2,566, 83.7 %). The most commonly used AED was carbamazepine (n = 1,292, 42.1 %; mostly in monotherapy 83.9 %). WWE were more likely to smoke and to have previous miscarriages, lower socioeconomic status, and more co-morbidity than the reference women with no epilepsy diagnosis and no AED use (WOE). A slightly increased risk for most of the perinatal health outcomes was found in offspring of WWE in relation to offspring of WOE (adjusted odds ratio [aOR] 1.19, 95 % CI 1.04-1.36 for low 5-min Apgar score to aOR 2.10, 95 % CI 1.57-2.81 for needing respiratory care). The risks increased by the number of different maternal AEDs used. In relation to offspring of WWE with no AED exposure (n = 1,800), a slightly increased risk for treatment in a neonatal care unit (aOR 1.48, 95 % CI 1.21-1.82) was observed for offspring of WWE on AED therapy. CONCLUSIONS: Offspring of WWE have a slightly increased risk for adverse pregnancy-related and perinatal health outcomes when compared with WOE, and AED exposure further increases the risk. The results should be interpreted with caution, as information on type of epilepsy was unavailable. Abstract INTRODUCTION: Perinatal health outcomes other than major congenital anomalies in offspring of women with epilepsy (WWE) have not been widely studied, and results of previous studies are conflicting and are mostly based on small numbers. Antiepileptic drugs (AEDs) pass through the placenta and may affect neonatal outcome. METHODS: This register-based study is based on information on all pregnancies ending in birth in Finland between 1996 and 2008. The data were obtained from the Finnish national health registers with data linkages based on the unique personal identification numbers. Information on maternal epilepsy diagnosis, AED purchases and other background factors was obtained to evaluate data on perinatal and infant health for all singleton births (n = 751,139). Drug purchases were considered to be an indicator for drug use. The outcomes included mode of delivery (vaginal birth or Caesarean section), preterm birth, low birth weight, weight for gestational age, low Apgar score, need for respiratory treatment, admission to neonatal care unit, perinatal death and infant death. RESULTS: In total, 4,867 (0.6 %) infants (including live births and stillbirths) were exposed to maternal epilepsy. More than half of the offspring of WWE were exposed to AED (n = 3,067, 63.0 %) during pregnancy or 1 month prior to and/or during pregnancy, and mostly in monotherapy (n = 2,566, 83.7 %). The most commonly used AED was carbamazepine (n = 1,292, 42.1 %; mostly in monotherapy 83.9 %). WWE were more likely to smoke and to have previous miscarriages, lower socioeconomic status, and more co-morbidity than the reference women with no epilepsy diagnosis and no AED use (WOE). A slightly increased risk for most of the perinatal health outcomes was found in offspring of WWE in relation to offspring of WOE (adjusted odds ratio [aOR] 1.19, 95 % CI 1.04-1.36 for low 5-min Apgar score to aOR 2.10, 95 % CI 1.57-2.81 for needing respiratory care). The risks increased by the number of different maternal AEDs used. In relation to offspring of WWE with no AED exposure (n = 1,800), a slightly increased risk for treatment in a neonatal care unit (aOR 1.48, 95 % CI 1.21-1.82) was observed for offspring of WWE on AED therapy. CONCLUSIONS: Offspring of WWE have a slightly increased risk for adverse pregnancy-related and perinatal health outcomes when compared with WOE, and AED exposure further increases the risk. The results should be interpreted with caution, as information on type of epilepsy was unavailable.
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Keywords

cesarean deliveries
 
confounders
 
congenital malformations
 
epileptic women
 
gestational diabetes mellitus
 
higher rate
 
higher rates
 
maternal outcomes
 
medical center
 
multiple logistic regression model
 
multivariable analysis
 
patients
 
population-based study
 
possible confounders
 
pregnancy outcome
 
prenatal care
 
singleton pregnancies
 
Stratified analysis
 
study period 139 168 singleton deliveries
 
tertiary medical center