Depressive, anxiety symptoms more common in pregnant women with epilepsy
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Pregnant women with epilepsy had higher rates of depressive and anxiety symptoms during and after pregnancy compared with women who were pregnant only or had epilepsy only, according to data published in Neurology.
However, these women were no more likely to have major depression compared with their counterparts.
“Given the increased risks and impact of adverse mood and anxiety, pregnant women with epilepsy should be routinely assessed, and symptomatic patients should be offered treatment,” Kimford J. Meador, MD, a professor of neurology and neurosciences and director of the Comprehensive Epilepsy Program at Stanford University in Stanford, California, told Healio.
Study design
The present study was part of the ongoing, NIH-funded Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study investigating pregnant women with epilepsy (PWWE) and healthy pregnant women without epilepsy (HPW) and their children, and a cohort of nonpregnant women with epilepsy (NPWWE), all of whom were recruited between December 2012 and January 2016.
Meador and colleagues assessed 331 PWWE, 102 HPW and 102 NPWWE for major depressive episodes, depression symptoms and anxiety symptoms at set time points. They evaluated pregnant women during each trimester, near delivery and every 3 months within the first 9 months postpartum; they conducted evaluations at comparable time points for NPWWE.
Prevalence of depression, anxiety
Overall, 17.5% of PWWE, 22.2% of NPWWE and 13.4% of HPW had a history of mood disorders and 16.2% of PWWE, 25.3% of NPWWE and 15.5% of HPW had a history of anxiety disorders.
The incidence of major depressive episodes did not differ across groups. Among PWWE, factors associated with major depressive episodes included having at least one seizure every 90 days, anticonvulsant polytherapy, unplanned pregnancy and a history of mood disorder.
During pregnancy, PWWE were significantly more likely to have depressive symptoms compared with their nonpregnant counterparts (37.2% vs. 30.4% [reference]; adjusted OR = 0.6; 95% CI, 0.3-1). Following delivery, PWWE were significantly more likely to have depressive symptoms compared with HPW (8.9% vs. 2.1% [reference]; aOR = 0.3; 95% CI, 0.1-1.2).
PWWE had significantly worse anxiety symptoms compared with both other groups during the pregnancy time period. After delivery, PWWE only had significantly worse anxiety compared with HPW.
Meador also noted that suicidal ideation was greater in women with greater anxiety symptoms.
In a related editorial, Andres M. Kanner, MD, a neurologist at the University of Miami in Florida, suggested that in addition to routine screening during pregnancy, women with epilepsy should also undergo “a careful psychiatric history” when planning a pregnancy.
References:
- Kanner AM. Neurology. 2022;doi:10.1212/WNL.0000000000201171.
- Meador KJ, et al. Neurology. 2022;doi:10.1212/WNL.0000000000200958.