Pregnancy, delivery and outcome for the child in maternal epilepsy

ArticleinEpilepsia 50(9):2130-9 · June 2009with28 Reads
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.
    • "The teratogenicity of AEDs is one of the main challenges when treating female patients with epilepsy. Several pregnancy registries have reported higher rates of major congenital malformations with the use of VPA during pregnancy, compared to other AEDs, such as CBZ or LTG (Wide et al., 2004; Artama et al., 2005; Wyszynski et al., 2005; Morrow et al., 2006; Vajda et al., 2007; Harden et al., 2009; Veiby et al., 2009). VPA has been recently reported to be associated with an increased risk of spina bifida, atrial septal defects, cleft palate, and craniosynostosis (Jentink et al., 2010). "
    [Show abstract] [Hide abstract] ABSTRACT: Epilepsy is a chronic neurological disorder in adults and requires treatment with antiepileptic medication. While the majority of patients with epilepsy can be treated with medication, about one third will fail on medical treatment. Therefore, other treatment options such as surgery, devices, and the ketogenic diet are other options to consider, in addition to medical treatment. The treatment of epilepsy requires many other factors to be taken into consideration, and these include, but are not limited to, age, gender, coexistent medical conditions, and the use of concomitant medications. The goal of treatment is to provide optimal seizure control while using the least possible number of medications, particularly for young females at reproductive age or the elderly who may suffer from other medical diseases and receive other concomitant medications. Certain conditions may co-exist with epilepsy, such as migraine, mood disorder, and memory disturbances, therefore the decision to choose the most appropriate medication for epilepsy patients should also involve treatment of these conditions. Here, we review current clinical practice in epilepsy and focus on the most common problems and conditions that clinicians face on a daily basis to treat adult patients with epilepsy. Side effect profiles, spectrum of efficacy and optimal choices per predominant type of seizures are summarized and can be used for educational purposes.
    Article · Jul 2016
    • "Moreover, we should consider that several conditions, such as advanced maternal age, low parity, low Bishop score and low duration of labour are at a higher risk of caesarean section [37, 38], independently from the epileptic status. As far as neonatal outcomes are concerned , there have been identified small for gestational age children (SGA) [39, 40], low Apgar score at 1 min [34], deterioration of potential long-term cognition [41] and perinatal death [42]. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: The physiological changes during pregnancy can significantly alter antiepileptic drug (AED)'s absorption, distribution, metabolism and elimination, thus influencing their plasma concentration. Considering that the risks of using old and new AEDs during pregnancy are still debated, our aim is to review the available evidence on this topic. Methods: Narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases. Results: The old AEDs generation (benzodiazepines, phenytoin, carbamazepine, phenobarbital and valproic acid) is teratogenic: minor congenital malformations, such as facial dysmorphism and other anomalies, occur in 6-20 % of infants exposed to AEDs in utero; this value is two times greater than the value reported in the general population. Major congenital malformations (MCM) such as cleft lip and cleft palate, heart defects (atrial septal defect, Fallot's tetralogy, ventricular septal defect, aortic coarctation, patent ductus arteriosus, and pulmonary stenosis) and urogenital anomalies were estimated to be 4-6 % of infants born from mothers treated with AEDs, compared to 2-3 % of the general population. Conclusion: It is essential to inform women treated with AED that planning pregnancy is necessary, when possible. The problems related to antiepileptic therapy and the possibilities of prenatal diagnosis should be accurately discussed with the patient, when possible before pregnancy: individual circumstances, desire to have children, severity of epilepsy, risks of seizures, family history of congenital malformations and all other potential risk factors must be considered, involving the patient in shared clinical decision-making.
    Full-text · Article · Nov 2015
    • "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. "
    Full-text · Dataset · May 2015 · Archives of Gynecology and Obstetrics
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