Article

Prenancy, delivery and outcome for the child in maternal epilepsy

Department of Clinical Medicine, Section for Neurology, University of Bergen, Norway.
Epilepsia (Impact Factor: 4.57). 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. "

    Full-text · Dataset · May 2015
    • "In our study, about one-third of babies were delivered preterm and 21.2% of babies were born with LBW. Even though, the sample size is small, the spectrum of reported fetal complications in our patients is similar to those reported elsewhere.[315] Although drug treatment presents a risk of such neonatal outcomes,[315] recent report by Chen et al. 2009,[32] showed that the occurrence of seizures itself is associated with the risk of having preterm delivery, LBW and SGA neonates. "
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    ABSTRACT: In addition to changes in seizure frequency, pregnant women with epilepsy (WWE) are at increased risk of complications during pregnancy or delivery. In the absence of a nationwide WWE registry, hospital-based studies may provide important information regarding current management and outcomes in these patients. The aims of this study were to determine changes in seizure frequency, and pregnancy and birth outcomes among pregnant WWE. We conducted a retrospective review of medical records of pregnant patients with epilepsy, who obtained medical care (from 2006 to 2011) at one of the general hospitals in the North-Eastern State of Malaysia. Data were collected for seizure frequency before and during the pregnancy, concurrent medications, pregnancy complications, and neonatal outcomes. We reviewed records of 25 patients with a total of 33 different pregnancies. All patients were treated with antiepileptic medications during their pregnancies, with 42% monotherapy and 58% polytherapy. Seizure frequency decreased in 5 (15.2%), increased in 18 (54.5%) and unchanged in 10 (30.3%) cases of pregnancies. Pregnancy complications were anemia, gestational diabetes mellitus, gestational hypertension, intrauterine growth retardation, premature rupture of membrane, and vaginal bleeding. Preterm deliveries were recorded in 11 (33.3%) infants. In our setting, many patients were being on polytherapy during their pregnancies. This underscores the need for planned pregnancies so that antiepileptic medications can be optimized prior to pregnancy.
    No preview · Article · Oct 2013 · Annals of Indian Academy of Neurology
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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. "

    Full-text · Dataset · May 2013
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