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Leite MDL, Topocov TN, de Oliveira TL, Almeida DDS, Mota Ortiz SR, da Silva JC. Obstetric and neonatal outcomes, antiseizure medication profile, and seizure types in pregnant women in a vulnerability state from Brazil. PLoS One 2024; 19:e0291190. [PMID: 38558080 PMCID: PMC10984515 DOI: 10.1371/journal.pone.0291190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/24/2023] [Indexed: 04/04/2024] Open
Abstract
This retrospective cohort study described the obstetric and neonatal outcomes, antiseizure medication (ASM) use, and types of seizures in pregnant women with epilepsy (PWWE). Data collected from the medical records of 224 PWWE aged < 40 years with controlled or refractory seizures and 492 pregnant women without epilepsy (PWNE) control group from high-risk maternity hospitals in Alagoas between 2008 and 2021 were included in this study. The obstetric and neonatal outcomes observed in PWWE were pregnancy-related hypertension (PrH) (18.4%), oligohydramnios (10.3%), stillbirth (6.4%), vaginal bleeding (6%), preeclampsia (4.7%), and polyhydramnios (3%). There was a greater likelihood of PrH in PWWE with generalized tonic-clonic seizures (GTCS) and that of maternal intensive care unit (ICU) admissions in those with GTCS and status epilepticus, and phenytoin and lamotrigine use. PWWE with GTCS had a higher risk of stillbirth and premature delivery. PWWE with status epilepticus were treated with lamotrigine. Phenobarbital (PB) with diazepam were commonly used in GTCS and status epilepticus. Total 14% patients did not use ASM, while 50.2% used monotherapy and 35.8% used polytherapy. Total 60.9% of patients used PB and 25.2% used carbamazepine. This study described the association between the adverse obstetric and neonatal outcomes and severe seizure types in PWWE.
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Affiliation(s)
- Magnúcia de Lima Leite
- Universidade Estadual de Ciências da Saúde Alagoas (UNCISAL), Maceió, AL, Brazil
- Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | | | | | - Sandra Regina Mota Ortiz
- Universidade Municipal de São Caetano do Sul (USCS), São Paulo, SP, Brazil
- Universidade São Judas Tadeu (USJT), São Paulo, SP, Brazil
| | - José Claudio da Silva
- Faculdade de Medicina do Centro Universitário(CESMAC), Maceió, AL, Brazil
- PPGSF/RENASF/FIOCRUZ/UNCISAL, Maceió, AL, Brazil
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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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de Lima Leite M, Toporcov TN, Pai JD, da Silva JC. Socio-demographic profiles and obstetrics outcomes of pregnant women with epilepsy in a vulnerability State, Brazil. PLoS One 2022; 17:e0271328. [PMID: 35857720 PMCID: PMC9299315 DOI: 10.1371/journal.pone.0271328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The socio-demographic profile of pregnant women in low- and middle- income countries is characterized by low educational attainment and unemployment, leading to social and economic morbidity. characterized by limited opportunities for education, employment, and marriage, which are strongly related to the stigmatization of the disease. The study of the socio- profile and obstetric outcomes of pregnant women with epilepsy in Alagoas, Brazil, may help understand this scenario and facilitate the development of public policy strategies to reduce local morbidity. OBJECTIVES We aimed to describe the sociodemographic profile of pregnant women with epilepsy and obstetric outcomes in Alagoas, Brazil. METHODS This cohort study was based on medical records of pregnant women with epilepsy in Brazilian high-risk maternity hospitals from 2008 to 2020. The following data were collected: age, race, education, marital status, occupation, number of pregnancies, delivery, and abortion. The inclusion criteria were pregnant women with and without epilepsy (control group) aged < 40 years. RESULTS The prevalence of PWWE was 0.49% (n = 224/44,917). Cesarean delivery was more frequent in PWWE than in pregnant women without epilepsy (adjusted odds ratio [OR] = 22.0; 95% confidence interval [CI] = 14.35-33.73; p<0,01). Abortion was associated with PWWE (OR adjusted = 1.72; 95% CI = 1.13-2.61; p = 0.01). Pregnant women in the countryside were more likely to develop epilepsy than those born in the capital (OR = 1.55; 95% CI = 1.12-2.14; p <0.01). CONCLUSION The PWWE socio-demographic profile of the Alagoas had a predominance of brown- colored skin, single status, homemakers, and illiteracy with a high proportion residing in the interior of the state. The obstetrics data show a higher incidence of cesarean deliveries and miscarriages.
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Affiliation(s)
- Magnúcia de Lima Leite
- Universidade Estadual de Ciências da Saúde Alagoas (UNCISAL), Maceió, AL, Brazil
- Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Janise Dal Pai
- Universidade Pontifícia Católica do Rio Grande do Sul (PUCRS), Rio Grande do Sul, RS, Brazil
| | - José Claudio da Silva
- Universidade Estadual de Ciências da Saúde Alagoas (UNCISAL), Maceió, AL, Brazil
- Faculdade de Medicina do Centro Universitário (CESMAC), Maceió, AL, Brazil
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