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Vajda FJE, O'Brien TJ, Graham JE, Hitchcock AA, Perucca P, Lander CM, Eadie MJ. Teratogenicity of zonisamide and other little-used antiseizure medications. Seizure 2024; 117:198-201. [PMID: 38460459 DOI: 10.1016/j.seizure.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/22/2024] [Accepted: 03/02/2024] [Indexed: 03/11/2024] Open
Abstract
PURPOSE To investigate the risk of teratogenesis occurring in relation to intrauterine exposure to infrequently used antiseizure medications in Australia. METHODS Analysis of data contained in the Raoul Wallenberg Australian Pregnancy Register of Antiepileptic Drugs. RESULTS There was statistically significant evidence that zonisamide, but not any other of nine infrequently used antiseizure medications in Australia, was associated with a risk of teratogenesis related to the maternal dose of the drug taken in at least the earlier half of pregnancy. CONCLUSIONS The teratogenesis associated with zonisamide, like that associated with topiramate and possibly acetazolamide, may be an expression of a class effect shared among sulphonamide-derived carbonic anhydrase inhibitors that possess anti-seizure activity.
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Affiliation(s)
- Frank J E Vajda
- Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3050, Australia; Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Janet E Graham
- Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Alison A Hitchcock
- Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Piero Perucca
- Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3050, Australia; Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia; Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, VIC 3084, Australia; Bladin-Berkovic Comprehensive Epilepsy Program, Austin Health, Heidelberg, VIC 3084, Australia
| | - Cecilie M Lander
- Royal Brisbane and Women's Hospital and School of Medicine and Biomedical Science, University of Queensland, Brisbane, QLD 4027, Australia
| | - Mervyn J Eadie
- Royal Brisbane and Women's Hospital and School of Medicine and Biomedical Science, University of Queensland, Brisbane, QLD 4027, Australia
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Mazzone PP, Hogg KM, Weir CJ, Stephen J, Bhattacharya S, Chin RFM. Comparison of Perinatal Outcomes for Women With and Without Epilepsy: A Systematic Review and Meta-analysis. JAMA Neurol 2023; 80:484-494. [PMID: 36912826 PMCID: PMC10012044 DOI: 10.1001/jamaneurol.2023.0148] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/12/2023] [Indexed: 03/14/2023]
Abstract
Importance Pregnant women who have epilepsy need adequate engagement, information, and pregnancy planning and management to improve pregnancy outcomes. Objective To investigate perinatal outcomes in women with epilepsy compared with women without epilepsy. Data Sources Ovid MEDLINE, Embase, CINAHL, and PsycINFO were searched with no language or date restrictions (database inception through December 6, 2022). Searches also included OpenGrey and Google Scholar and manual searching in journals and reference lists of included studies. Study Selection All observational studies comparing women with and without epilepsy were included. Data Extraction and Synthesis The PRISMA checklist was used for abstracting data and the Newcastle-Ottawa Scale for risk-of-bias assessment. Data extraction and risk-of-bias assessment were done independently by 2 authors with mediation conducted independently by a third author. Pooled unadjusted odds ratios (OR) or mean differences were reported with 95% CI from random-effects (I2 heterogeneity statistic >50%) or fixed-effects (I2 < 50%) meta-analyses. Main Outcomes and Measures Maternal, fetal, and neonatal complications. Results Of 8313 articles identified, 76 were included in the meta-analyses. Women with epilepsy had increased odds of miscarriage (12 articles, 25 478 pregnancies; OR, 1.62; 95% CI, 1.15-2.29), stillbirth (20 articles, 28 134 229 pregnancies; OR, 1.37; 95% CI, 1.29-1.47), preterm birth (37 articles, 29 268 866 pregnancies; OR, 1.41; 95% CI, 1.32-1.51) and maternal death (4 articles, 23 288 083 pregnancies; OR, 5.00; 95% CI, 1.38-18.04). Neonates born to women with epilepsy had increased odds of congenital conditions (29 articles, 24 238 334 pregnancies; OR, 1.88; 95% CI, 1.66-2.12), neonatal intensive care unit admission (8 articles, 1 204 428 pregnancies; OR, 1.99; 95% CI, 1.58-2.51), and neonatal or infant death (13 articles, 1 426 692 pregnancies; OR, 1.87; 95% CI, 1.56-2.24). The increased odds of poor outcomes was increased with greater use of antiseizure medication. Conclusions and Relevance This systematic review and meta-analysis found that women with epilepsy have worse perinatal outcomes compared with women without epilepsy. Women with epilepsy should receive pregnancy counseling from an epilepsy specialist who can also optimize their antiseizure medication regimen before and during pregnancy.
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Affiliation(s)
- Paolo Pierino Mazzone
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Child Life and Health, Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Christopher J. Weir
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jacqueline Stephen
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, United Kingdom
| | - Sohinee Bhattacharya
- The Institute of Applied Health Sciences, Aberdeen Centre for Women’s Health Research, University of Aberdeen, Aberdeen, United Kingdom
| | - Richard F. M. Chin
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom
- Royal Hospital for Children and Young People, Edinburgh, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Child Life and Health, Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
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Gao H, Hao N, Liu S, Zhou D. Seizure frequency and obstetric complications at advanced maternal age: a preliminary observational study in women with epilepsy. ACTA EPILEPTOLOGICA 2021. [DOI: 10.1186/s42494-021-00052-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Seizure control during pregnancy and obstetric outcomes are of important concerns for women with epilepsy (WWE) and their families. Advanced maternal age (≥35 years) shows a growing trend in the society with changes of lifestyle, which also occurs in diseased populations. The advanced maternal age is an independent factor for some unsatisfying obstetric outcomes. In this study we explored the seizure control and obstetric complications associated with advanced maternal age in WWE.
Methods
This study was based on the epilepsy pregnancy registry at West China Hospital. Patients with epilepsy in this registry who were aged 35 or older when starting pregnancy were included in this study. Their basic demographics and detailed information on epilepsy management and obstetric issues in all trimesters and during 1-year follow-up after birth were documented and reviewed. Data were processed by IBM SPSS version 22.0. The demographic characteristics, seizure frequency, treatment change, obstetric complications, and outcomes were analyzed and compared.
Results
Fifteen patients were included in this study, with an average age of 36.32 ± 2.39 years at pregnancy, and 73.33% of them were primiparas. The change of seizure frequency during pregnancy was not in a clear pattern, but there was an increased incidence of tonic-clonic seizures during the mid- and last trimesters. More than 20% of the patients had obstetric complications throughout the trimesters, including vaginal bleeding, hypothyroidism, and pre-eclampsia. The pre-eclampsia seemed extraordinarily complicated with other conditions. However, none of the complications were related with malformations or poor outcome of babies after 1-year follow-up.
Conclusion
Advanced maternal age combined with WWE is associated with frequent common obstetric complications. Future controlled studies with large sample sizes are needed to explore the related risks in comparison with other WWE and non-epileptic populations.
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Işıkalan MM, Gündoğan KM, Acar A. Peripartum hemorrhage and other obstetric and neonatal outcomes in pregnant women with epilepsy: A single-center study. Epilepsy Res 2021; 171:106566. [PMID: 33524872 DOI: 10.1016/j.eplepsyres.2021.106566] [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: 11/30/2020] [Revised: 12/28/2020] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE There are inconsistent results in different studies on maternal and fetal complications of pregnant women with epilepsy (PWWE). The differences may be in part due to racial characteristics. The aim of this study was to investigate if there is an increase in obstetric and neonatal complications, especially postpartum hemorrhage, in pregnant women with epilepsy in the Turkish population. METHODS In a tertiary center, PWWE and the control group were compared in terms of obstetric and neonatal complications as well as postpartum hemorrhage. Among 46,789 deliveries, 154 eligible PWWE were matched 1: 3 with the control group. RESULTS There was no increase in the possibility of peripartum hemorrhage and blood transfusion in PWWE. However, the probability of cesarean delivery was higher in PWWE (adjusted OR: 3.24 CI: 1.95-5.42, p < 0.001). Moreover, an increase in the possibility of fetal growth restriction, fetal death, admission to the neonatal intensive care unit and lower APGAR scores were found in PWWE. CONCLUSION Although the risk of peripartum hemorrhage does not appear to be increased in PWWE, cesarean rates and fetal complications do increase. There is also a need for prospective studies examining long-term neonatal outcomes in pregnancies complicated by epilepsy.
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Affiliation(s)
- Mehmet Murat Işıkalan
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine Unit, Meram Faculty of Medicine, Necmettin Erbakan University, Beysehir Street, No:281 Akyokus, 42080, Konya, Turkey.
| | - Kübra Memnune Gündoğan
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine Unit, Meram Faculty of Medicine, Necmettin Erbakan University, Beysehir Street, No:281 Akyokus, 42080, Konya, Turkey.
| | - Ali Acar
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine Unit, Meram Faculty of Medicine, Necmettin Erbakan University, Beysehir Street, No:281 Akyokus, 42080, Konya, Turkey.
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Bansal R, Jain G, Kharbanda P, Goyal M, Suri V. Maternal and neonatal complications during pregnancy in women with epilepsy. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.ijep.2016.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractEpilepsy is the commonest serious neurological problem faced by obstetricians and gynaecologists. Epidemiological studies estimate epilepsy to complicate 0.3–0.7% of all pregnancies.1 2 The importance of epilepsy in pregnancy lies in the fact that many women with epilepsy (WWE) have to go through their pregnancy while taking antiepileptic (AED) drugs. Both the seizures and AEDs can have harmful effects on the mother as well the foetus. Thus, during pregnancy, the clinician faces dual challenge of controlling seizures as well as preventing teratogenicity of AEDs.1 In this review we discuss the possible impact of seizures as well as AEDs on mother as well as the child. We try to answer some of the commonest questions which are relevant to successful management of pregnancy and ensuring birth of a healthy baby.
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Affiliation(s)
- R. Bansal
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - G. Jain
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - P. Kharbanda
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - M. Goyal
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - V. Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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Soontornpun A, Choovanichvong T, Tongsong T. Pregnancy outcomes among women with epilepsy: A retrospective cohort study. Epilepsy Behav 2018; 82:52-56. [PMID: 29587185 DOI: 10.1016/j.yebeh.2018.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The objective of this study was to compare adverse pregnancy outcomes between pregnancies that involve epilepsy and those that do not and are identified as normal for the purposes of this paper. METHODS A retrospective cohort study was carried out by accessing the maternal-fetal medicine (MFM) database to identify and review records of singleton pregnancies with epilepsy but with no other underlying disease (study group). A parallel group of low-risk pregnancies was randomly allocated as the control group. The adverse outcomes between the two groups were compared. The primary outcomes included rates of spontaneous abortion, small for gestational age (SGA), preterm birth (PTB), low birth weight (LBW), and preeclampsia. RESULTS From a total of 44,708 deliveries, 148 pregnancies involving mothers with epilepsy and a control group of 1480 normal pregnancies were compared. The rates of spontaneous abortion, PTB, LBW, and cesarean section were slightly but significantly higher in the study group with a relative risk of 6.6 (95% confidence interval (CI): 1.9-23.3), 1.6 (95% CI: 1.1-2.2), 1.6 (95% CI: 1.1-2.3), and 1.5 (95% CI: 1.1-2.1), respectively, whereas other adverse outcomes were comparable. In the subgroup analysis, adverse outcomes tended to be higher in women with active epilepsy. However, only the rates of SGA in the group in which the disorder is active and PTB in the presence of seizures within 6months of conception were significantly increased. CONCLUSIONS Pregnancies with epilepsy, even in cases with multidisciplinary care and no other risk factors, are still significantly associated with higher adverse outcomes.
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Affiliation(s)
- Atiwat Soontornpun
- Department of Internal Medicine, Faculty of Medicine Chiang Mai University, Thailand
| | | | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Thailand.
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Güveli BT, Rosti RÖ, Güzeltaş A, Tuna EB, Ataklı D, Sencer S, Yekeler E, Kayserili H, Dirican A, Bebek N, Baykan B, Gökyiğit A, Gürses C. Teratogenicity of Antiepileptic Drugs. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2017; 15:19-27. [PMID: 28138106 PMCID: PMC5290711 DOI: 10.9758/cpn.2017.15.1.19] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/06/2015] [Accepted: 03/25/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Antiepileptic drugs (AED) have chronic teratogenic effects, the most common of which are congenital heart disease, cleft lip/palate, urogenital and neural tube defects. The aim of our study is to examine teratogenic effects of AED and the correlation between these malformations and AED in single or multiple pregnancies. METHODS This is a retrospective study of malformations in children born to mothers currently followed up by our outpatient clinics who used or discontinued AED during their pregnancy. Their children were then investigated using echocardiography, urinary ultrasound, cranial magnetic resonance image, and examined by geneticists and pediatric dentists. RESULTS One hundred and seventeen children were included in the study. Ninety one of these children were exposed to AED during pregnancy. The most commonly used AED were valproic acid and carbamazepine in monotherapy. The percentage of major anomaly was 6.8% in all children. Dysmorphic features and dental anomalies were observed more in children exposed especially to valproic acid. There were 26 mothers with two and four mothers with three pregnancies from the same fathers. No correlation was found between the distribution of malformations in recurring pregnancies and AED usage. CONCLUSION Our study has the highest number of dysmorphism examined in literature, found in all the children exposed to valproic acid, which may account for the higher rate of facial dysmorphism and dental anomalies. On lower doses of valproic acid, major malformations are not seen, although the risk increases with polytherapy. Our data also indicate possible effects of genetic and environmental factors on malformations.
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Affiliation(s)
- Betül Tekin Güveli
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul University, Istanbul,
Turkey
| | - Rasim Özgür Rosti
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul,
Turkey
| | - Alper Güzeltaş
- Department of Pediatric Cardiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul,
Turkey
| | - Elif Bahar Tuna
- Department of Pedodonty, Faculty of Dentistry, Istanbul University, Istanbul,
Turkey
| | - Dilek Ataklı
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul University, Istanbul,
Turkey
| | - Serra Sencer
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul,
Turkey
| | - Ensar Yekeler
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul,
Turkey
| | - Hülya Kayserili
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul,
Turkey
| | - Ahmet Dirican
- Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University, Istanbul,
Turkey
| | - Nerses Bebek
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul,
Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul,
Turkey
| | - Ayşen Gökyiğit
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul,
Turkey
| | - Candan Gürses
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul,
Turkey
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Viale L, Allotey J, Cheong-See F, Arroyo-Manzano D, Mccorry D, Bagary M, Mignini L, Khan KS, Zamora J, Thangaratinam S. Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet 2015; 386:1845-52. [PMID: 26318519 DOI: 10.1016/s0140-6736(15)00045-8] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Antenatal care of women with epilepsy is varied. The association of epilepsy and antiepileptic drug exposure with pregnancy outcomes needs to be quantified to guide management. We did a systematic review and meta-analysis to investigate the association between epilepsy and reproductive outcomes, with or without exposure to antiepileptic drugs. METHODS We searched MEDLINE, Embase, Cochrane, AMED, and CINAHL between Jan 1, 1990, and Jan 21, 2015, with no language or regional restrictions, for observational studies of pregnant women with epilepsy, which assessed the risk of obstetric complications in the antenatal, intrapartum, or postnatal period, and any neonatal complications. We used the Newcastle-Ottawa Scale to assess the methodological quality of the included studies, risk of bias in the selection and comparability of cohorts, and outcome. We assessed the odds of maternal and fetal complications (excluding congenital malformations) by comparing pregnant women with and without epilepsy and undertook subgroup analysis based on antiepileptic drug exposure in women with epilepsy. We summarised the association as odds ratio (OR; 95% CI) using random effects meta-analysis. The PROSPERO ID of this Systematic Review's protocol is CRD42014007547. FINDINGS Of 7050 citations identified, 38 studies from low-income and high-income countries met our inclusion criteria (39 articles including 2,837,325 pregnancies). Women with epilepsy versus those without (2,809,984 pregnancies) had increased odds of spontaneous miscarriage (OR 1·54, 95% CI 1·02-2·32; I(2)=67%), antepartum haemorrhage (1·49, 1·01-2·20; I(2)=37%), post-partum haemorrhage (1·29, 1·13-1·49; I(2)=41%), hypertensive disorders (1·37, 1·21-1·55; I(2)=23%), induction of labour (1·67, 1·31-2·11; I(2)=64%), caesarean section (1·40, 1·23-1·58; I(2)=66%), any preterm birth (<37 weeks of gestation; 1·16, 1·01-1·34; I(2)=64%), and fetal growth restriction (1·26, 1·20-1·33; I(2)=1%). The odds of early preterm birth, gestational diabetes, fetal death or stillbirth, perinatal death, or admission to neonatal intensive care unit did not differ between women with epilepsy and those without the disorder. INTERPRETATION A small but significant association of epilepsy, exposure to antiepileptic drugs, and adverse outcomes exists in pregnancy. This increased risk should be taken into account when counselling women with epilepsy. FUNDING EBM CONNECT Collaboration.
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Affiliation(s)
- Luz Viale
- Centro Rosarino de Estudios Perinatales, Rosario, Argentina
| | - John Allotey
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Fiona Cheong-See
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | - Manny Bagary
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | | | - Khalid S Khan
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Multidisciplinary Evidence Synthesis Hub, Queen Mary University of London, London, UK
| | - Javier Zamora
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Hospital Ramón y Cajal, Madrid, Spain; CIBER Epidemiology and Public Health, Madrid, Spain.
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Multidisciplinary Evidence Synthesis Hub, Queen Mary University of London, London, UK
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Borthen I. Obstetrical complications in women with epilepsy. Seizure 2015; 28:32-4. [PMID: 25843764 DOI: 10.1016/j.seizure.2015.02.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/05/2015] [Accepted: 02/10/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Better knowledge of risk factors for women with epilepsy giving birth. METHOD Investigating all studies reporting complications in pregnancy and deliveries in women with epilepsy during the last 15 years. RESULTS Studies have observed that women with epilepsy have a higher risk of preeclampsia, gestational hypertension, bleeding in pregnancy, caesarean delivery (CD), excessive bleeding postpartum, preterm birth, and small for gestational age. It has been unclear whether the increased risk of complications is due to the epilepsy per se, the use of antiepileptic drugs (AED), or the combination of both factors. Recent studies strongly indicate an association between AED use, and complications in pregnancy and labour. CONCLUSION Newer drugs commonly used in treatment of epilepsy are associated with an increased risk of pregnancy complications, as well as complication during labour and delivery.
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Affiliation(s)
- Ingrid Borthen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
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Abstract
Epilepsy is the most commonly encountered neurologic disorder during pregnancy. A majority of women with epilepsy continue antiepileptic drug regimens during pregnancy. To provide evidence-based care to women with epilepsy, it is critical that healthcare providers possess a basic knowledge of seizures, antiepileptic medications, and interventions specific to this patient population, as well as an understanding of the patient's basic needs and concerns. This article provides a discussion of seizure types, common antiepileptic medications, and provides evidence-based interventions related to the fetus and the mother during preconception, intrapartum, and postpartum periods.
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Affiliation(s)
- Donna Jean Ruth
- Association of Women's Health, Obstetric and Neonatal Nurses, Washington, District of Columbia 20036, USA.
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Abstract
PURPOSE OF REVIEW Epilepsy is a common neurological disorder affecting 0.4-0.8% of pregnant women. Preeclampsia, gestational hypertension, bleeding in pregnancy, induction of labour, caesarean delivery and major congenital malformations of the children occur more frequently in this group. The objective of this review is to evaluate the pregnancy and delivery complications including congenital abnormalities in women with epilepsy. This review comments on results of recently published studies including the Medical Birth Registry of Norway. A second aim of the review is to examine the effect of antiepileptic-drug treatment on pregnancy complications, and also their association with congenital abnormalities associated with these medications. RECENT FINDINGS Women with epilepsy have a higher risk of preeclampsia, gestational hypertension, bleeding in pregnancy and excessive bleeding postpartum. They also have higher incidence of congenital anomalies and delayed cognitive development in their children. It has been unclear whether the increased risk of complications is due to the epilepsy per se, the use of antiepileptic drugs, or the combination of both factors. Recent studies strongly indicate an association to the medications and the dose used in pregnancy. SUMMARY Several drugs commonly used in treatment of epilepsy are associated with increased pregnancy complications, as well as an increased risk of congenital abnormalities.
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Borthen I, Eide MG, Daltveit AK, Gilhus NE. Obstetric outcome in women with epilepsy: a hospital-based, retrospective study. BJOG 2011; 118:956-65. [PMID: 21557799 DOI: 10.1111/j.1471-0528.2011.03004.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the complications during pregnancy and delivery in women with epilepsy, compared with a control group without epilepsy, with special focus on potential risk factors, such as epilepsy severity and dosage of antiepileptic drugs. DESIGN Hospital-based retrospective study. SETTING Data from pregnancy notification forms and hospital case records. POPULATION Women with a past or present history of epilepsy (n = 205) delivered in Bergen, Norway, in the period 1999-2006, and a matched control group of women (n = 205) without epilepsy. METHODS Data were compared and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by multiple logistic regression models. MAIN OUTCOME MEASURES Pre-eclampsia (mild and severe), gestational hypertension, vaginal bleeding (early and late), caesarean section, vaginal operative delivery, postpartum haemorrhage and major malformations. RESULTS Women with epilepsy using antiepileptic drugs had an increased risk of severe pre-eclampsia (OR, 5.0; 95% CI, 1.3-19.9), bleeding in early pregnancy (OR, 6.4; 95% CI, 2.7-15.2), induction (OR, 2.3; 95% CI, 1.2-4.3) and caesarean section (OR, 2.5; 95% CI, 1.4-4.7) adjusted for maternal age, parity, education, smoking, medical conditions and body mass index ≥30 kg/m(2) . There was also an increased risk of malformations in the offspring (OR, 7.1; 95% CI, 1.4-36.6). Women without antiepileptic drug use had increased risks of forceps delivery and preterm birth. Active epilepsy (seizures during the last 5 years) versus nonactive epilepsy did not discriminate for any of these complications; 84.5% of women with epilepsy and antiepileptic drug use were using folate. CONCLUSION Women with epilepsy using antiepileptic drugs had an increased risk of pregnancy and delivery complications, whereas women not using antiepileptic drugs had few complications. Seizures, high doses of antiepileptic drugs, obesity and lack of folate could not explain these increased risks.
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Affiliation(s)
- I Borthen
- Department of Clinical Medicine, University of Bergen, Norway.
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Borthen I, Eide MG, Daltveit AK, Gilhus NE. Delivery outcome of women with epilepsy:a population-based cohort study. BJOG 2010; 117:1537-43. [DOI: 10.1111/j.1471-0528.2010.02694.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The majority of epileptic disorders are not self-limiting over time, and therefore require a long-lasting and often even lifelong antiepileptic drug (AED) treatment, in Wi/omen with epilepsy, the influence of their disease on the possibility and course of pregnancies, as well as the potential impact of the AED treatment on mother and child, are crucial questions. This review addresses the clinically relevant knovledge concerning the impact of the disease itself and the AED treatment on fertility, pregnancy, delivery, the postpartum period, and teratogenicity. Some of the new AEDs appear to have a favorable profile due to a lack of clinically relevant interactions and promising teratogenic profiles. However, the finding of decreases in lamotrigine serum concentrations during hormonal contraception and pregnancy is an instructive example, shovt/ing that ongoing studies are urgently needed to further investigate stillunanswered questions. Several prospective multinational surveys are currently being performed, and should add essential information in this context.
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Hitiris N, Mohanraj R, Norrie J, Brodie MJ. Mortality in epilepsy. Epilepsy Behav 2007; 10:363-76. [PMID: 17337248 DOI: 10.1016/j.yebeh.2007.01.005] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 01/19/2007] [Accepted: 01/20/2007] [Indexed: 10/23/2022]
Abstract
All studies report an increased mortality risk for people with epilepsy compared with the general population. Population-based studies have demonstrated that the increased mortality is often related to the cause of the epilepsy. Common etiologies include neoplasia, cerebrovascular disease, and pneumonia. Deaths in selected cohorts, such as sudden unexpected death in epilepsy (SUDEP), status epilepticus (SE), suicides, and accidents are more frequently epilepsy-related. SUDEP is a particular cause for concern in younger people, and whether and when SUDEP should be discussed with patients with epilepsy remain problematic issues. Risk factors for SUDEP include generalized tonic-clonic seizures, increased seizure frequency, concomitant learning disability, and antiepileptic drug polypharmacy. The overall incidence of SE may be increasing, although case fatality rates remain constant. Mortality is frequently secondary to acute symptomatic disorders. Poor compliance with treatment in patients with epilepsy accounts for a small proportion of deaths from SE. The incidence of suicide is increased, particularly for individuals with epilepsy and comorbid psychiatric conditions. Late mortality figures in patients undergoing epilepsy surgery vary and are likely to reflect differences in case selection. Future studies of mortality should be prospective and follow agreed guidelines to better quantify risk and causation in individual populations.
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Affiliation(s)
- Nikolas Hitiris
- Epilepsy Unit, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, Scotland, UK
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Chang TY, Lai CW, Yu HY, Hsu JJ, Shih YH, Chen CP. Preliminary descriptive statistics of the Taiwanese Registry of Epilepsy and Pregnancy for the first 2 years. Taiwan J Obstet Gynecol 2007; 46:47-9. [PMID: 17389189 DOI: 10.1016/s1028-4559(08)60106-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To present the descriptive statistics of the Taiwanese Registry of Epilepsy and Pregnancy (TREP) for the first 2 years. MATERIALS AND METHODS The pregnancies were recruited from May 2004 to January 2006 with a data format compatible with the International Registry of Antiepileptic Drugs and Pregnancy (EURAP) by referral. The data were collected from either face-to-face interview, telephone interview, or chart review by a research nurse. Five questionnaires (A-E) were required for each pregnancy. The preliminary data for the first 2 years are presented with general descriptive statistics. RESULTS Until January 2006, 43 pregnancies have been registered. Questionnaire A was completed in 43 cases, questionnaire B completed in 40 cases, questionnaire C completed in 34 cases, questionnaire D completed in 27 cases, and questionnaire E in eight cases. Among the 39 pregnancies known to take antiepileptic drugs (AEDs) during pregnancy, 28 pregnancies took one AED, nine pregnancies took two AEDs, and two pregnancies took three AEDs. The most commonly used drug was carbamazepine (19/39, 48.72%). Among the 27 pregnancies, who had delivered, the cesarean section rate was 44.44% (12/27), the premature birth rate was 7.41% (2/27), and the fetal malformation rate was 3.7% (1/27). CONCLUSION The preliminary data concluded the efforts of TREP for the first 2 years. Although it is still premature to project a trend out of current data, the registry is expected to provide critical information to local prenatal counseling and contribute further to the international EURAP database.
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Affiliation(s)
- Tung-Yao Chang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
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