Adverse Perinatal Outcomes and Epilepsy: Is it the Disorder or the Treatment?
BACKGROUND AND PURPOSE:
Most studies have focused on antiepileptic drugs (AEDs), birth defects and cognition in offspring
Some studies have looked at the effect of epilepsy itself on poor pregnancy outcomes, but few studies have looked at large population datasets required to sort out the contributions of epilepsy and AEDs
Razaz et al. (JAMA Neurology, 2017) investigated associations between epilepsy and adverse perinatal outcomes including the potential influence of AEDs
Population-based retrospective nationwide cohort study
Singleton births at 22 or more completed gestational weeks
Data on AED exposure was available in a subset of offspring
Researcher looked at both pregnancy outcomes (e.g., preeclampsia, chorioamnionitis, abruption), mode of delivery and perinatal outcomes (e.g., stillbirth, preterm birth, congenital malformations, small for gestational age [SGA])
Comparisons were made between outcomes of women with epilepsy who were receiving AEDs vs those with epilepsy not receiving medication
Analyzed consecutive births from the same mother, to adjust for confounders such as maternal preexisting conditions
Final cohort set included 1,424,279 pregnancies, of 869,947 mothers
5373 births were in 3586 women with epilepsy with a mean age of 30.54 years
Most common AEDs
Valproic acid (19.2%)
13.3% were exposed to polytherapy
Pregnancy Outcomes: Compared with no-epilepsy pregnancies, women with epilepsy were at an increased risk of
Elective cesarean section
Emergency cesarean section
Perinatal Outcomes: Infants of mothers with epilepsy were at increased risk of
SGA live birth
Any and major malformations
Asphyxia-related neonatal complications
Low 5-minute Apgar scores
Neonatal hypoglycemia and Respiratory distress
In women with epilepsy, using AEDs during did not increase the risks of pregnancy complications, except for a higher rate of labor induction
Increased perinatal complications were of borderline significance included respiratory distress (6.0% vs 4.5%); SGA live birth (9.5% vs 6.9%); and major malformations (6.7% vs 4.7%)
Valproic acid poses a greater risk for major malformation
Epilepsy during pregnancy is associated with increased risks of adverse pregnancy and perinatal outcomes
AED use during pregnancy is generally not associated with adverse outcomes
Epilepsy and possible related conditions (autoimmune disorders) appear to be responsible for majority of adverse pregnancy and perinatal adverse outcomes
women with epilepsy should not be advised to discontinue clinically indicated treatment
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