Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria 3050, Australia; Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.
Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia.
Epilepsy Behav. 2022 Sep;134:108848. doi: 10.1016/j.yebeh.2022.108848. Epub 2022 Jul 18.
To utilize data from the Australian Register of Antiepileptic Drugs in Pregnancy (APR) to determine the hazard of fetal malformation in the subsequent pregnancy or pregnancies in women with epilepsy following a pregnancy associated with a fetal malformation, and to identify factors relevant to the hazard.
There was a 7.4% initial pregnancy fetal malformation rate. The subsequent pregnancy malformation rate was 4.2% if there was no initial pregnancy malformation, but 21.2% if there was an initial pregnancy malformation (O.R. = 6.1448, 95% C.I. 2.3396, 16.1386). For pregnancies where antiseizure medication (ASM) therapy was unchanged between pregnancies (N = 196), the initial pregnancy malformation rate was 10.2%, but 30.0% in the subsequent pregnancy if there was a malformation in the initial pregnancy, and 2.35% if there was none (O.R. = 17.7857, 95% C.I. 4.4847, 70.5361). A cohort comprising 24% of the women with fetal malformations in their initial pregnancies seemed to be intrinsically vulnerable to fetal malformation during successive pregnancies: when their seizure disorder type had been recorded all had genetic generalized epilepsies, compared with a 45.8% generalized epilepsy rate in women with initial but not subsequent pregnancy malformations (P = 0.0121).
If fetal malformation had occurred in an initial ASM-treated pregnancy there was a significantly increased hazard of fetal malformation in the subsequent pregnancy, particularly if the woman involved had a genetic generalized epilepsy.
利用澳大利亚抗癫痫药物妊娠登记处（APR）的数据，确定在与胎儿畸形相关的妊娠后，癫痫女性在随后的妊娠或妊娠中胎儿畸形的危险，并确定与危险相关的因素。
初始妊娠胎儿畸形率为 7.4%。如果初始妊娠无畸形，随后妊娠的畸形率为 4.2%，但如果初始妊娠有畸形，畸形率为 21.2%（OR=6.1448，95%CI 2.3396，16.1386）。对于两次妊娠之间抗癫痫药物（ASM）治疗未改变的妊娠（N=196），初始妊娠畸形率为 10.2%，但如果初始妊娠有畸形，随后妊娠的畸形率为 30.0%，如果没有畸形，畸形率为 2.35%（OR=17.7857，95%CI 4.4847，70.5361）。一个包含 24%在初始妊娠中出现胎儿畸形的女性的队列似乎在随后的妊娠中对胎儿畸形具有内在的脆弱性：当她们的癫痫发作类型被记录时，所有这些女性都患有遗传性全面性癫痫，而在初始但非随后妊娠中出现畸形的女性中，全面性癫痫的发生率为 45.8%（P=0.0121）。
如果在初始 ASM 治疗的妊娠中发生胎儿畸形，那么在随后的妊娠中胎儿畸形的危险显著增加，特别是如果涉及的女性患有遗传性全面性癫痫。
