Departments of Medicine and Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, and the Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada; the Keenan Research Institute, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, the Institute for Clinical Evaluative Sciences, the Department of Psychiatry, University of Toronto, Women's College Hospital Research Institute, the Departments of Medicine and Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, the Department of Medicine, Sunnybrook Hospital, University of Toronto, Sunnybrook Hospital Research Institute, the Department of Medicine, Mount Sinai Hospital, University of Toronto, and the Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Obstet Gynecol. 2017 Dec;130(6):1327-1333. doi: 10.1097/AOG.0000000000002364.
To evaluate the incidence rate and relative risk of a seizure disorder after eclampsia.
We evaluated 1,565,733 births in a retrospective data linkage cohort study in Ontario, Canada, from April 1, 2002, to March 31, 2014. We included females aged 15-50 years and excluded patients with epilepsy, conditions predisposing to seizure, and those who died within 30 days of the delivery discharge date. The exposure was defined as a hypertensive disorder of pregnancy, namely 1) eclampsia, 2) preeclampsia, or 3) gestational hypertension. The referent was an unaffected pregnancy. The primary outcome was the risk of seizure disorder starting 31 days after a hospital birth discharge. Risk was expressed as an incidence rate and a hazard ratio (HR) with 95% CI. The predefined study hypothesis was that women with eclampsia would have an increased risk of future seizure disorder.
There were 1,615 (0.10%) pregnancies exclusively affected by eclampsia, 17,264 (1.1%) with preeclampsia, 60,863 (3.9%) with gestational hypertension, and 1,485,991 (94.9%) unaffected. A future seizure disorder was significantly more likely after a pregnancy with eclampsia (4.58/10,000 person-years) than a pregnancy without a hypertensive disorder of pregnancy (0.72/10,000 person-years; crude HR 6.09, 95% CI 2.73-13.60). The adjusted HR was minimally attenuated from 6.09 to 5.42 (95% CI 2.42-12.12) after multivariable adjustment for confounders at the index birth as well as adjusting for traumatic brain injury, stroke, cerebral tumor, aneurysm or hemorrhage, and multiple sclerosis. The risk of seizure disorder was doubled in pregnancies affected by preeclampsia (adjusted HR 1.96, 95% CI 1.21-3.17), but not by gestational hypertension (adjusted HR 1.01, 95% CI 0.71-1.43).
Women with eclampsia should be reassured that, although the relative risk of a seizure disorder is higher than unaffected women, the absolute risk is extremely low (approximately one seizure/2,200 person-years).
评估子痫后癫痫发作障碍的发生率和相对风险。
我们在加拿大安大略省进行了一项回顾性数据链接队列研究，纳入了 2002 年 4 月 1 日至 2014 年 3 月 31 日期间的 1565733 例分娩。我们纳入了年龄在 15-50 岁之间的女性，并排除了癫痫患者、易发生癫痫的疾病患者以及分娩出院后 30 天内死亡的患者。暴露定义为妊娠高血压疾病，包括 1）子痫，2）子痫前期，或 3）妊娠期高血压。参考组为未受影响的妊娠。主要结局是自医院分娩出院后 31 天开始出现癫痫发作障碍的风险。风险以发病率和风险比（HR）及 95%置信区间表示。研究假设是子痫患者未来发生癫痫发作障碍的风险增加。
仅有 1615 例（0.10%）妊娠仅受子痫影响，17264 例（1.1%）受子痫前期影响，60863 例（3.9%）受妊娠期高血压影响，1485991 例（94.9%）未受影响。与无妊娠高血压疾病的妊娠相比，子痫后发生癫痫发作障碍的可能性显著增加（4.58/10000 人年），而无妊娠高血压疾病的妊娠为 0.72/10000 人年（粗 HR 6.09，95%CI 2.73-13.60）。在指数分娩时对混杂因素进行多变量调整后，调整后的 HR 从 6.09 降至 5.42（95%CI 2.42-12.12），并且在调整创伤性脑损伤、中风、脑肿瘤、动脉瘤或出血、多发性硬化症后，调整后的 HR 也有所降低。子痫前期（调整后的 HR 1.96，95%CI 1.21-3.17）会使妊娠癫痫发作的风险增加一倍，但妊娠期高血压（调整后的 HR 1.01，95%CI 0.71-1.43）不会。
尽管子痫后癫痫发作障碍的相对风险高于未受影响的女性，但绝对风险极低（约每 2200 人年发生一次癫痫发作），因此子痫患者应放心。
