From the Stanford University (K.J.M.), CA; University of Wisconsin at Madison (Z.N.S.); Emmes Company (C.B., C.P.R., A.G.M.), Rockville, MD; University of Southern California (L.A.K.), Los Angeles; Brigham & Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Evanston, IL; Minnesota Epilepsy Group (P.P.), Roseville; Emory University (E.R.G.), Atlanta, GA; University of Cincinnati (J.C.), OH; University of Pittsburgh (P.B.P.), PA.
Neurology. 2022 Oct 11;99(15):e1573-e1583. doi: 10.1212/WNL.0000000000200958. Epub 2022 Aug 17.
Assess the incidence and factors associated with major depressive episodes (MDEs) and symptoms of depression and anxiety during pregnancy and postpartum periods in pregnant women with epilepsy (PWWE) compared with healthy pregnant women (HPW) and nonpregnant women with epilepsy (NPWWE) in comparable timeframes. Previous studies have reported higher rates of postpartum depression in women with epilepsy compared with women without epilepsy. However, the incidence of MDE using a structured interview during pregnancy and postpartum has not been directly compared with control groups, and the comparison of depression and anxiety symptoms and the role of associated factors remain ambiguous.
The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs study is a multicenter NIH-funded prospective observational parallel group cohort study of PWWE and their children. This report examines mood disorders. Unlike previous epilepsy pregnancy studies, the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV (SCID) provided lifetime diagnoses, and repeated SCID mood modules assessed for MDE, the a priori primary outcome. Symptoms of depression (Beck Depression Inventory [BDI] and Edinburg Postnatal Depression Scale [EPDS]) and anxiety (Beck Anxiety Inventory [BAI]) were also assessed along with multiple clinical factors.
This study included PWWE (n = 331) and HPW (n = 102) during pregnancy and postpartum and NPWWE (n = 102) at comparable times. No difference in SCID-diagnosed MDE incidence was found across groups, but BDI depressive symptoms were worse during pregnancy in PWWE vs NPWWE and during postpartum vs HPW and NPWWE. BAI anxiety symptoms were worse during pregnancy in PWWE vs HPW and NPWWE and during postpartum vs HPW. Factors associated with MDE during pregnancy/postpartum for PWWE included >1 seizure/90 days, anticonvulsant polytherapy, unplanned pregnancy, and lifetime history of mood disorder. Suicidal ideation from BDI or EPDS was related to BAI anxiety symptoms.
Although SCID-based MDE did not differ across groups, this prospective study confirms higher rates of psychiatric symptoms in patients with epilepsy during pregnancy and postpartum, provides new data on associated factors, and underscores the importance of anxiety in risk for depression and thoughts of death/dying or suicide. Given the risks, PWWE should be routinely assessed and symptomatic patients should be offered treatment.
This study is registered at ClinicalTrials.gov as NCT01730170.
评估癫痫孕妇（PWWE）与健康孕妇（HPW）和非癫痫孕妇（NPWWE）在可比时间内怀孕期间和产后出现重度抑郁发作（MDE）和抑郁与焦虑症状的发生率及其相关因素。先前的研究报告称，癫痫女性产后抑郁的发生率高于无癫痫女性。然而，怀孕期间和产后使用结构性访谈评估 MDE 的发生率尚未与对照组直接比较，且抑郁和焦虑症状的比较以及相关因素的作用仍不清楚。
MATERNAL OUTCOMES AND NEURODEVELOPMENTAL EFFECTS OF ANTIEPILEPTIC DRUGS 研究是一项由美国国立卫生研究院（NIH）资助的多中心前瞻性观察性平行组队列研究，纳入了 PWWE 及其子女。本报告探讨了心境障碍。与以往的癫痫妊娠研究不同，使用《精神障碍诊断与统计手册》第四版（DSM-IV）的结构性临床访谈（SCID）提供了终生诊断，并且重复的 SCID 心境模块评估了 MDE，即预先确定的主要结局。还评估了抑郁症状（贝克抑郁量表 [BDI]和爱丁堡产后抑郁量表 [EPDS]）和焦虑症状（贝克焦虑量表 [BAI]），以及多种临床因素。
这项研究纳入了怀孕期间和产后的 PWWE（n=331）和 HPW（n=102）以及同期的 NPWWE（n=102）。在各组之间未发现 SCID 诊断的 MDE 发生率存在差异，但 PWWE 组在怀孕期间的 BDI 抑郁症状比 NPWWE 组更严重，在产后比 HPW 和 NPWWE 组更严重。PWWE 组在怀孕期间的 BAI 焦虑症状比 HPW 组和 NPWWE 组更严重，在产后比 HPW 组更严重。PWWE 组怀孕期间和产后发生 MDE 的相关因素包括：每 90 天发作＞1 次、抗癫痫药物多药治疗、计划外妊娠和心境障碍的终生病史。BDI 或 EPDS 的自杀意念与 BAI 焦虑症状有关。
尽管各组之间的 SCID 诊断的 MDE 没有差异，但这项前瞻性研究证实了癫痫患者在怀孕期间和产后出现更高的精神症状发生率，提供了相关因素的新数据，并强调了焦虑在抑郁和死亡/自杀念头或自杀风险中的重要性。鉴于这些风险，PWWE 应进行常规评估，出现症状的患者应给予治疗。
本研究在 ClinicalTrials.gov 注册，编号为 NCT01730170。
