Allotey John, Aroyo-Manzano David, Lopez Patricia, Viale Luz, Zamora Javier, Thangaratinam Shakila
Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London London, UK.
Hospital Ramón y Cajal (IRYCIS), Madrid, Spain; CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
Eur J Obstet Gynecol Reprod Biol. 2017 Aug;215:12-19. doi: 10.1016/j.ejogrb.2017.05.016. Epub 2017 May 30.
Women with epilepsy are at risk of pregnancy complications. Whether these vary globally is unknown. We undertook a systematic review to assess the overall rates of obstetric outcomes in women with epilepsy, and variations in estimates across geographical region, economic status of country, and over time.
We searched Medline, Embase, Cochrane, AMED and CINAHL, (January 1, 1990 and November 29, 2016), without any language restrictions for studies reporting core maternal and fetal outcomes in women with epilepsy. We pooled the results using Freeman-Tukey Transformation random effectsanalysis, and reported our findings as rates of complications per 100 pregnancies with 95% confidence intervals (CI). We assessed for differences in risk across World Health Organisation (WHO) regions, income status, and year of publication.
From the 7420 articles screened, we included 60 studies (62 articles). In women with epilepsy (116,105 pregnancies), the commonest complications were caesarean section (29.2 per 100 pregnancies; 95% CI 25.4-33.1, I=98.44%), and admission to the neonatal intensive care unit (12.5 per 100 pregnancies; 95% CI 9.6-15.8, I=60.63%). There were significant differences across the WHO regions, with the highest rates of caesarean section (37%, 95% CI 32%-42%); spontaneous miscarriage (39%, 95% CI 35%-44%) and preterm birth (10%, 95% CI 8%-12%) in the Americas; postpartum haemorrhage (9%, 95% CI 7%-12%), hypertensive disorders (14%, 95% CI 8%-21%) and perinatal death (2%, 95% CI 1%-7%) in the Western Pacific; induction of labour (30%, 95% CI 19%-41%) in South East Asia and antepartum haemorrhage (10%, 95% CI 5%-17%) in the Eastern Mediterranean. The reported rates of antepartum haemorrhage, caesarean section, gestational diabetes and spontaneous miscarriage were highest in high income and high-middle income countries. Over time, there was a significant increase in caesarean section, and reduction in stillbirths, perinatal deaths and admission to the neonatal intensive care unit in women with epilepsy.
There is significant variation in reported maternal and offspring outcomes in pregnant women with epilepsy across geographical regions, economic status of country and over time, which needs to be considered in setting priorities for clinical management and research.
癫痫女性有发生妊娠并发症的风险。这些并发症在全球范围内是否存在差异尚不清楚。我们进行了一项系统综述，以评估癫痫女性产科结局的总体发生率，以及不同地理区域、国家经济状况和时间变化的发生率差异。
我们检索了Medline、Embase、Cochrane、AMED和CINAHL（1990年1月1日至2016年11月29日），对报告癫痫女性核心母婴结局的研究没有任何语言限制。我们使用弗里曼 - 图基变换随机效应分析汇总结果，并将我们的发现报告为每100例妊娠的并发症发生率及95%置信区间（CI）。我们评估了世界卫生组织（WHO）各区域、收入状况和发表年份的风险差异。
在筛选的7420篇文章中，我们纳入了60项研究（62篇文章）。癫痫女性（116,105例妊娠）中，最常见的并发症是剖宫产（每100例妊娠29.2例；95%CI 25.4 - 33.1，I = 98.44%）和新生儿重症监护病房收治（每100例妊娠12.5例；95%CI 9.6 - 15.8，I = 60.63%）。WHO各区域存在显著差异，美洲剖宫产率最高（37%，95%CI 32% - 42%）、自然流产率（39%，95%CI 35% - 44%）和早产率（10%，95%CI 8% - 12%）；西太平洋地区产后出血率（9%，95%CI 7% - 12%）、高血压疾病率（14%，95%CI 8% - 21%）和围产期死亡率（2%，95%CI 1% - 7%）；东南亚引产率（30%，95%CI 19% - 41%）和东地中海产前出血率（10%，95%CI 5% - 17%）。高收入和高中等收入国家报告的产前出血、剖宫产、妊娠期糖尿病和自然流产率最高。随着时间推移，癫痫女性的剖宫产率显著上升，死产、围产期死亡和新生儿重症监护病房收治率下降。
癫痫孕妇报告的母婴结局在地理区域、国家经济状况和时间上存在显著差异，在制定临床管理和研究的优先事项时需要考虑这些因素。
