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Pekoz MT, Aslan-Kara K, Tekin B, Gurses C, Yeni SN, Bozdemir H, Keskin-Guler S, Ataklı D, Gul G, Eren F, Sarı H, Gul ZB, Ceyhan-Dirican A, Genc F, Bicer-Gomceli Y, Ozkara C, Delil S, Atalar AC, Bebek N, Baykan B, Bora İ, Bican-Demir A, Mısırlı CH, Tutkavul K, Velioglu SK, Ilhan-Algin D, Erdinc O, Saygi S, Tezer-Fılık I, Apaydın-Dogan E, Akyol A, Kamisli O, Yalcın AD, Cakmak G, Ersoy A, Ustun-Ozek S, Halac G, Kutlu G, Tantik-Pak A, Yücel SP. Birth outcomes in pregnant women with epilepsy: A Nationwide multicenter study from Türkiye. Epilepsia 2023; 64:2310-2321. [PMID: 37357418 DOI: 10.1111/epi.17692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE The present study was aimed at investigating the effects of anti-seizure medications (ASMs), patient demographic characteristics, and the seizure type and frequency on the development of congenital malformations (CMs) in the infants of pregnant women with epilepsy (PWWE). METHODS PWWE followed up at the neurology outpatient clinic of 21 centers between 2014 and 2019 were included in this prospective study. The follow-up of PWWE was conducted using structured, general pregnant follow-up forms prepared by the Pregnancy and Epilepsy Study Committee. The newborns were examined by a neonatologist after delivery and at 1 and 3 months postpartum. RESULTS Of the infants of 759 PWWE, 7.2% had CMs, with 5.6% having major CMs. Polytherapy, monotherapy, and no medications were received by 168 (22.1%), 548 (72.2 %), and 43 (5.7 %) patients, respectively. CMs were detected at an incidence of 2.3% in infants of PWWE who did not receive medication, 5.7% in infants of PWWE who received monotherapy, and 13.7% in infants of PWWE who received polytherapy. The risk of malformation was 2.31-fold (95% confidence interval (CI): 1.48-4.61, p < .001) higher in infants of PWWE who received polytherapy. Levetiracetam was the most frequently used seizure medication as monotherapy, with the highest incidence of CMs occurring with valproic acid (VPA) use (8.5%) and the lowest with lamotrigine use (2.1%). The incidence of CMs was 5% at a carbamazepine dose <700 mg, 10% at a carbamazepine dose ≥700 mg, 5.5% at a VPA dose <750 mg, and 14.8% at a VPA dose ≥750 mg. Thus the risk of malformation increased 2.33 times (p = .041) in infants of PWWE receiving high-dose ASMs. SIGNIFICANCE Birth outcomes of PWWE receiving and not receiving ASMs were evaluated. The risk of CMs occurrence was higher, particularly in infants of PWWE using VPA and receiving polytherapy. The incidence of CMs was found to be lower in infants of PWWE receiving lamotrigine.
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Affiliation(s)
- Mehmet Taylan Pekoz
- Department of Neurology, Çukurova University School of Medicine, Adana, Türkiye
| | - Kezban Aslan-Kara
- Department of Neurology, Çukurova University School of Medicine, Adana, Türkiye
| | - Betül Tekin
- Department of Neurology, University of Health Sciences, Bakırkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Hospital, Istanbul, Türkiye
| | - Candan Gurses
- Department of Neurology, Koç University School of Medicine, İstanbul, Türkiye
| | - Seher Naz Yeni
- Department of Neurology, Istanbul University-Cerrahpasa School of Medicine, Istanbul, Türkiye
| | - Hacer Bozdemir
- Department of Neurology, Çukurova University School of Medicine, Adana, Türkiye
| | - Selda Keskin-Guler
- Department of Neurology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Türkiye
| | - Dilek Ataklı
- Department of Neurology, University of Health Sciences, Bakırkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Hospital, Istanbul, Türkiye
| | - Gunay Gul
- Department of Neurology, University of Health Sciences, Bakırkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Hospital, Istanbul, Türkiye
| | - Fulya Eren
- Department of Neurology, University of Health Sciences, Bakırkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Hospital, Istanbul, Türkiye
| | - Hüseyin Sarı
- Department of Neurology, University of Health Sciences, Bakırkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Hospital, Istanbul, Türkiye
| | - Zeynep Baştug Gul
- Department of Neurology, University of Health Sciences, Bakırkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Hospital, Istanbul, Türkiye
| | - Ayten Ceyhan-Dirican
- Department of Neurology, University of Health Sciences, Bakırkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Hospital, Istanbul, Türkiye
| | - Fatma Genc
- Department of Neurology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Türkiye
| | | | - Cigdem Ozkara
- Department of Neurology, Istanbul University-Cerrahpasa School of Medicine, Istanbul, Türkiye
| | - Sakir Delil
- Department of Neurology, Istanbul University-Cerrahpasa School of Medicine, Istanbul, Türkiye
| | - Arife Cimen Atalar
- Department of Neurology, Istanbul University School of Medicine, Istanbul, Türkiye
| | - Nerses Bebek
- Department of Neurology, Istanbul University School of Medicine, Istanbul, Türkiye
| | - Betül Baykan
- Department of Neurology, Istanbul University School of Medicine, Istanbul, Türkiye
| | - İbrahim Bora
- Department of Neurology, Uludag University School of Medicine, Bursa, Türkiye
| | - Aylin Bican-Demir
- Department of Neurology, Uludag University School of Medicine, Bursa, Türkiye
| | - Cemile Handan Mısırlı
- Department of Neurology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Türkiye
| | - Kemal Tutkavul
- Department of Neurology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Türkiye
| | - Sibel K Velioglu
- Department of Neurology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
| | - Demet Ilhan-Algin
- Department of Neurology, Osmangazi University School of Medicine, Eskisehir, Türkiye
| | - Oguz Erdinc
- Department of Neurology, Osmangazi University School of Medicine, Eskisehir, Türkiye
| | - Serap Saygi
- Department of Neurology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Irsel Tezer-Fılık
- Department of Neurology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Ebru Apaydın-Dogan
- Department of Neurology, Akdeniz University School of Medicine, Antalya, Türkiye
| | - Ali Akyol
- Department of Neurology, Adnan Menderes University School of Medicine, Aydın, Türkiye
| | - Ozden Kamisli
- Department of Neurology, İnönü University Turgut Özal Medical Center Training and Research Hospital, Malatya, Türkiye
| | - A Destina Yalcın
- Department of Neurology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Gonul Cakmak
- Department of Neurology, Sanko University Faculty of Medicine, Gazıantep, Türkiye
| | - Alevtina Ersoy
- Department of Neurology, Erzincan Binali Yildirim University School of Medicine, Erzincan, Türkiye
| | - Sibel Ustun-Ozek
- Department of Neurology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Türkiye
| | - Gulistan Halac
- Department of Neurology, University of Health Sciences, Bezm-i Alem Valide Sultan Vakif Gureba Training and Research Hospital, Istanbul, Türkiye
| | - Gulnihal Kutlu
- Department of Neurology, Mugla Sıtkı Kocman University School of Medicine, Muğla, Türkiye
| | - Aygul Tantik-Pak
- Department of Neurology, University of Health Sciences, Gaziosmanpasa Training and Research Hospital, Istanbul, Türkiye
| | - Sevinc P Yücel
- Department of Biostatistics, Çukurova University School of Medicine, Adana, Türkiye
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