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Maternal epilepsy increases risk for adverse outcomes

Maternal epilepsy may increase the risk for adverse pregnancy, delivery and perinatal outcomes; however, maternal antiepileptic drug use is not usually associated with adverse events, according to findings published in JAMA Neurology.

“Among women with epilepsy, exposure to [antiepileptic drugs] during pregnancy may increase the risks of fetal growth restriction, induction of labor, postpartum hemorrhage, and admission to the neonatal intensive care unit compared with those who are not exposed to [antiepileptic drugs (AEDs)],” Neda Razaz, PhD, MPH, from the clinical epidemiology unit at Karolinska University Hospital, Karolinska Institutet in Stockholm, and colleagues wrote. “Still, robust evidence from population-based studies is sparse on the association between maternal epilepsy and risks of adverse pregnancy outcomes and the contribution of AEDs to these outcomes.”

To determine whether a link exists between maternal epilepsy and risk for adverse outcomes, and if using antiepileptic drugs influences these risks, researchers performed a population-based cohort study on all singleton births at 22 or more gestational weeks. They assessed 1,424,279 births from 1997 through 2011 that took place in Swedish hospitals, and information on antiepileptic drug exposure available in a subset of children from mid-2005 to the end of 2011. Adjustments were made for maternal age, country of origin, educational level, cohabitation with a partner, height, early pregnancy BMI, smoking, year of delivery, maternal presentational diabetes, hypertension and psychiatric disorders.

There were 5,373 births among 3,586 women with epilepsy during pregnancy. Researchers found that women with epilepsy were at increased risk for adverse pregnancy and delivery outcomes compared with women who did not have epilepsy, including higher risk of preeclampsia (adjusted risk ratio [aRR], 1.24; 95% CI, 1.07-1.43), infection (aRR, 1.85; 95% CI, 1.43-2.29), placental abruption (aRR, 1.68; 95% CI, 1.18-2.38), induction (aRR, 1.31; 95% CI, 1.21-1.40), elective cesarean section (aRR, 1.58; 95% CI, 1.45- 1.71), and emergency cesarean section (aRR, 1.09; 95% CI, 1.00-1.20). Compared with infants born to unaffected mothers, those born to mothers with epilepsy had higher risks for stillbirth (0.6% versus 0.3%), having major malformations (6.7% versus 4.7%) and experiencing respiratory distress (6.0% versus 4.5%). These infants were also more likely to experience any congenital malformations, asphyxia-related complications, Apgar score of 4 to 6 at 5 minutes, Apgar score of 0 to 3 at 5 minutes, neonatal hypoglycemia, preterm birth, being small for gestational age at birth and having neonatal infections. . Notably, using antiepileptic drugs during pregnancy did not increase the risk for pregnancy and perinatal complications in women with maternal epilepsy, excluding a higher rate of induction of labor (aRR, 1.30; 95% CI, 1.1-1.55).

“This information should improve counseling for women with epilepsy who contemplate discontinuing their treatment during pregnancy and provide useful information to their health care clinicians,” Razaz and colleagues wrote. “The impact of other possible confounders, such as disease severity, seizure frequency during pregnancy, dosage of AEDs exposure, AED serum levels, or exposure to other potential teratogens, needs to be assessed in future studies.” – by Savannah Demko

Disclosure: Razaz reports no relevant financial disclosure. Please see the full study for a complete list of all other authors’ relevant financial disclosures.