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Meador KJ, Pennell PB, May RC, Van Marter L, McElrath TF, Brown C, Gerard E, Kalayjian L, Gedzelman E, Penovich P, Cavitt J, French J, Hwang S, Pack AM, Sam M, Birnbaum AK, Finnell R. Fetal loss and malformations in the MONEAD study of pregnant women with epilepsy. Neurology 2020; 94:e1502-e1511. [PMID: 31806691 PMCID: PMC7251524 DOI: 10.1212/wnl.0000000000008687] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/11/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine occurrence of severe adverse fetal outcomes (SAO), including fetal loss and major congenital malformations (MCMs), in pregnant women with epilepsy (PWWE) vs healthy pregnant women (HPW). METHODS The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is an NIH-funded, prospective, observational, multicenter investigation of pregnancy outcomes for both mother and child, which enrolled women December 2012 through January 2016. RESULTS The 351 PWWE had 365 conceptions, and 105 HPW had 109 conceptions. SAOs occurred more often in PWWE (7.9%) vs HPW (1.9%) (p = 0.025) with odds ratio (OR) 4.45 (95% confidence intervals [CI] 1.04-19.01). There were no significant differences for fetal loss (2.8% vs 0%, p = 0.126) or MCMs (5.2% vs 1.9%, p = 0.185; OR 2.86, 95% CI 0.65-12.53) individually. No fetal losses in PWWE appeared to be related to acute seizures. Outcomes were not affected by periconceptional folate, unplanned/unwanted pregnancies, prior maternal pregnancy history, or antiepileptic drug (AED) blood levels, except for an AED level effect for fetal loss that appeared to be due to polytherapy. Combined maternal or paternal family history of MCM was marginally associated with increased SAOs (p = 0.046). CONCLUSIONS The findings provide additional information on risks of SAOs in PWWE, assessing effects of both AED levels and periconceptional folate. Group differences in average enrollment gestational age could have affected fetal loss results. Analyses are limited by small sample sizes as the MONEAD study was not powered for these secondary outcomes. The large majority of pregnancies in women with epilepsy do not have SOAs.
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Affiliation(s)
- Kimford J Meador
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX.
| | - Page B Pennell
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Ryan C May
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Linda Van Marter
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Thomas F McElrath
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Carrie Brown
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Elizabeth Gerard
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Laura Kalayjian
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Evan Gedzelman
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Patricia Penovich
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Jennifer Cavitt
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Jacqueline French
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Sean Hwang
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Alison M Pack
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Maria Sam
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Angela K Birnbaum
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
| | - Richard Finnell
- From Stanford University (K.J.M.), CA; Brigham & Women's Hospital (P.B.P., L.V.M., T.F.M.), Harvard Medical School, Boston, MA; Emmes (R.C.M., C.B.), Rockville, MD; Northwestern University (E.G.), Evanston, IL; University of Southern California (L.K.), Los Angeles; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (P.P.), St. Paul; University of Cincinnati (J.C.), OH; New York University (J.F.); Northwell Heath (S.H.); Columbia University (A.M.P.), New York, NY; Wake Forest University (M.S.), Winston-Salem, NC; University of Minnesota (A.K.B.), Minneapolis; and Baylor College of Medicine (R.F.), Houston, TX
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