1
|
Lavu A, Vaccaro C, Zusman E, Aboulatta L, Aloud B, Alessi-Severini S, Haidar L, Peymani P, Ng MC, Ruth C, Falk J, Desrochers B, Valencia E, Shouman W, Rabbani R, Eltonsy S. Antiseizure medication use during pregnancy and neonatal growth outcomes: A systematic review and meta-analysis. Br J Clin Pharmacol 2024; 90:1827-1837. [PMID: 37070633 DOI: 10.1111/bcp.15752] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/16/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023] Open
Abstract
AIMS We aimed to systematically synthesize the current published literature on neonatal growth outcomes associated with antiseizure medication (ASM) use during pregnancy. METHODS We searched seven databases, from inception to 23 March 2022. We investigated small for gestational age (SGA) and low birth weight (LBW) as primary outcomes and birth weight, birth height, cephalization index and head circumference as secondary outcomes. The primary analysis included pregnant people exposed to any ASM compared with unexposed pregnant people. Subgroup analysis included ASM class analysis, within epilepsy group analysis and polytherapy compared to monotherapy. RESULTS We screened 15 720 citations and included 65 studies in the review. Exposed pregnant people had a significantly increased risk of SGA relative risk (RR) 1.33 (95% CI 1.18 to 1.50, I2 74%), LBW RR 1.54 (95% CI 1.33 to 1.77, I2 67%), and decreased birth weight with a mean difference (MD) of -118.87 (95% CI -161.03 to -76.71, I2 42%) g. A non-significant risk change in birth height and head circumference was observed. In subgroup analysis, ASM polytherapy, within epilepsy and ASM class analysis were also associated with an increased risk of SGA and LBW. CONCLUSIONS This meta-analysis demonstrates that pregnant people exposed to ASMs have a significantly increased risk of adverse fetal growth outcomes including SGA and LBW and decreased birth weight compared to unexposed pregnant people. Polytherapy was associated with higher risks compared to monotherapy. Additional studies are warranted on specific ASM risks.
Collapse
Affiliation(s)
- Alekhya Lavu
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine Vaccaro
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Enav Zusman
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Laila Aboulatta
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Basma Aloud
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Lara Haidar
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Payam Peymani
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marcus C Ng
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea Ruth
- Max Rady School of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jamison Falk
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Eunice Valencia
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Walid Shouman
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rasheda Rabbani
- Max Rady School of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sherif Eltonsy
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
2
|
Vajda F. My profile in epilepsy. Epilepsy Behav 2017; 68:216-219. [PMID: 28038864 DOI: 10.1016/j.yebeh.2016.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Frank Vajda
- Departments of Medicine and Neuroscience, University of Melbourne Royal Melbourne Hospital, Parkville 3052, Victoria, Australia.
| |
Collapse
|
3
|
Margulis AV, Mittleman MA, Glynn RJ, Holmes LB, Hernández-Díaz S. Effects of gestational age at enrollment in pregnancy exposure registries. Pharmacoepidemiol Drug Saf 2015; 24:343-52. [PMID: 25702683 DOI: 10.1002/pds.3731] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 09/11/2014] [Accepted: 10/02/2014] [Indexed: 11/08/2022]
Abstract
PURPOSE This study aims to explore the influence of gestational age at enrollment, and enrollment before or after prenatal screening, on the estimation of drug effects in pregnancy exposure registries. METHODS We assessed the associations between first trimester antiepileptic drug (AED) exposure and risk of spontaneous abortion and major congenital malformations in the North American AED Registry (1996-2013). We performed logistic regression analyses, conditional or unconditional on gestational age at enrollment, to estimate relative risk (RR) for first trimester AED users compared with non-users. We also compared first trimester users of valproic acid and lamotrigine. Analyses were repeated in women who enrolled before prenatal screening. RESULTS Enrollment occurred earlier among 7029 AED users than among 581 non-users; it was similar among AEDs. Comparing AED users with non-users, RR (95% confidence interval) of spontaneous abortion (n = 359) decreased from 5.1 (2.3-14.1) to 2.0 (0.9-5.6) after conditioning on gestational week at enrollment and to 1.9 (0.8-5.4) upon further restriction to before-screening enrollees. RR of congenital malformations (n = 216) changed from 3.1 (1.4-8.5) to 3.2 (1.4-9.0) after conditioning on gestational week at enrollment and to 2.0 (0.7-10.1) upon further restriction to before-screening enrollees. When comparing valproic acid users and lamotrigine users, the RR of congenital malformations was not substantially changed by conditioning or restricting. CONCLUSIONS Spontaneous abortion rates were sensitive to gestational age at enrollment. Estimates of congenital malformation risks for AED users relative to non-users were sensitive to before/after-screening enrollment. This difference was not apparent between active drugs, likely due to similar gestational age at enrollment.
Collapse
Affiliation(s)
- Andrea V Margulis
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | | | | | | | | |
Collapse
|
5
|
Vajda FJE, O'Brien TJ, Lander CM, Eadie MJ. The rationale for pregnancy registers for women with epilepsy. Med J Aust 2011; 195:8-9. [DOI: 10.5694/j.1326-5377.2011.tb03179.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Frank J E Vajda
- Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC
| | - Terence J O'Brien
- Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC
| | - Cecilie M Lander
- Royal Brisbane and Women's Hospital and University of Queensland, Brisbane, QLD
| | - Mervyn J Eadie
- Central Clinical School, University of Queensland, Brisbane, QLD
| |
Collapse
|