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Li R, Chen Q, Cao X, Yan H, Wang P, Huang Q, Li X, Chen F, Li Y, Kong Q, Guo C, Zhang Q, Hong Q, Liu Y, Xiong X, Han Y, Xiao X, Wang K, Wu X, Zhu X, Zhang Q, Chen L. Pregnancy characteristics and adverse outcomes in offspring of women with epilepsy: a prospective registry study from Mainland China. Front Neurol 2023; 14:1195003. [PMID: 37638195 PMCID: PMC10455922 DOI: 10.3389/fneur.2023.1195003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Objective This study aimed to explore the influencing factors of adverse outcomes in the offspring of women with epilepsy (WWE) and to analyze the changes brought about by the epilepsy knowledge popularization campaign in China (EKPCIC). Methods This nested case-control study focused on WWE and their offspring from a female epilepsy cohort in mainland China. From January 2009 to August 2022, WWE was prospectively enrolled in 32 study centers. This study aimed to observe the health outcomes of their offspring within 1 year of age. The main outcome measure assessed the health status of the offspring within their first year of age. We aimed to analyze the effects of seizures, anti-seizure medicines (ASMs), and a lack of folic acid supplementation on adverse outcomes in the offspring of WWE and to explore the changes in perinatal management and adverse outcomes of the offspring after dissemination of the EKPCIC in 2015. Additionally, subgroup analyses were conducted to compare seizure control during pregnancy between the valproate and non-valproate groups. Results In total, 781 pregnancies in 695 WWE were included, of which 186 (23.69%) had adverse outcomes. The National Hospital Epilepsy Severity Scale score, number of seizures, status epilepticus, ASM type, and valproate and folic acid doses were associated with a high risk of adverse outcomes. After the EKPCIC, the use of ASMs (P = 0.013) and folic acid (P < 0.001), the seizure-free rate during pregnancy (P = 0.013), and the breastfeeding rate (P < 0.001) increased, whereas the incidence of complications during pregnancy decreased (P = 0.013). However, there was no significant difference in the incidence of adverse outcomes between the analyzed offspring pre-/post-EKPCIC. Additionally, there was no association between the frequency of seizures at different time points during pregnancy and the use of valproate (F = 1.514, P = 0.221). Conclusion Possible factors influencing adverse outcomes in the offspring of WWE include seizures, type and number of ASM usage, and a lack of folic acid supplementation. Although the management of WWE during pregnancy is now more standardized, further efforts are needed to reduce adverse outcomes in offspring.
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Affiliation(s)
- Rui Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Chen
- Department of Clinical Research Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xing Cao
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hua Yan
- Department of Neurology, Jianyang People's Hospital, Chengdu, Sichuan, China
| | - Pei Wang
- Department of Neurology, Xianyang First People's Hospital, Xianyang, Shanxi, China
| | - Qun Huang
- Department of Pediatrics, The WenJiang Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Xiaoyi Li
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Fang Chen
- Department of Neurology, Panzhihua Central Hospital, Panzhihua, Sichuan, China
| | - Yangchao Li
- Department of Neurology, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
| | - Qingxia Kong
- Department of Neurology, Affiliated Hospital of Jining Medical College, Jining, Shandong, China
| | - Chonglun Guo
- Epilepsy Center, Suichuan County People's Hospital, Suichuan, Jiangxi, China
| | - Qi Zhang
- Department of Neurology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, Sichuan, China
| | - Qiulei Hong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong Liu
- Department of Neurology, The First Affiliation Hospital of Xi'an Jiaotong University, Xian, Shanxi, China
| | - Xiaoli Xiong
- Department of Neurology, Guangyuan Mental Health Center, Guangyuan, Sichuan, China
| | - Yanbing Han
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiaohua Xiao
- Department of Geriatric Medicine, Shenzhen Second People's Hospital, Shenzhen, Guangzhou, China
| | - Kuiyun Wang
- Department of Neurology, The Jintang First People's Hospital, Chengdu, Sichuan, China
| | - Xunyi Wu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xi Zhu
- Department of Neurology, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Qing Zhang
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Hophing L, Kyriakopoulos P, Bui E. Sex and gender differences in epilepsy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:235-276. [PMID: 36038205 DOI: 10.1016/bs.irn.2022.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sex and gender differences in epilepsy are important influencing factors in epilepsy care. In epilepsy, the hormonal differences between the sexes are important as they impact specific treatment considerations for patients at various life stages particularly during early adulthood with establishment of the menstrual cycle, pregnancy, perimenopause and menopause. Choice of antiseizure medication may have direct consequences on hormonal cycles, hormonal contraception, pregnancy and fetal risk of major congenital malformation. Conversely hormones whether intrinsic or extrinsically administered may have direct impact on antiseizure medications and seizure control. This chapter explores these important influences on the management of persons with epilepsy.
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Affiliation(s)
- Lauren Hophing
- Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Canada
| | | | - Esther Bui
- Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Canada.
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Vajda FJE, O’Brien TJ, Graham JE, Hitchcock AA, Lander CM, Eadie MJ. Pregnancy outcomes in women with surgically treated epilepsy. Acta Neurol Scand 2021; 144:473-477. [PMID: 34236700 DOI: 10.1111/ane.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To ascertain whether epileptic seizure control during pregnancy differed between Australian women with previously surgically treated epilepsy, and those with only medically treated epilepsy. MATERIALS/METHODS Analysis of data for 74 pregnancies of women with surgically treated focal epilepsy, compared with that from 1013 pregnancies in women with medically treated focal epilepsy, both groups drawn from the Australian Register of Antiepileptic Drugs in Pregnancy between 1999 and 2020. RESULTS Seizures of all types, and also convulsive seizures, were less well controlled during pregnancy in the previously surgically treated cases, the difference for seizures of all types (68.9% versus 50.1%) being statistically significant (p < .05). This result was contrary to the outcome of a previously published study of the same question carried out in India. CONCLUSIONS At present, it may be premature to conclude that previous epilepsy surgery will be associated with a better chance of seizure-free, or seizure-controlled, pregnancy.
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Affiliation(s)
- Frank JE Vajda
- Department of Medicine and Neurosciences Royal Melbourne Hospital and University of Melbourne Parkville VIC Australia
- Department of Neurology Alfred Hospital & Department of Neuroscience Monash University Melbourne VIC Australia
| | - Terence J O’Brien
- Department of Neurology Alfred Hospital & Department of Neuroscience Monash University Melbourne VIC Australia
| | - Janet E Graham
- Department of Medicine and Neurosciences Royal Melbourne Hospital and University of Melbourne Parkville VIC Australia
| | - Alison A Hitchcock
- Department of Medicine and Neurosciences Royal Melbourne Hospital and University of Melbourne Parkville VIC Australia
| | - Cecilie M Lander
- Royal Brisbane and Women’s Hospital and School of Medicine and Biomedical Science University of Queensland Brisbane QLD Australia
| | - Mervyn J Eadie
- Royal Brisbane and Women’s Hospital and School of Medicine and Biomedical Science University of Queensland Brisbane QLD Australia
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