Afyonkarahisar University of Health Sciences, Faculty of Medicine, Department of Neurology, Zafer Health Complex Dortyol Mah. 2078 Street, No: 3, Block A, Pk. 03030, Afyonkarahisar, Turkey.
Afyonkarahisar State Hospital, Department of Neurology, Afyonkarahisar, Turkey.
Epilepsy Behav. 2024 Sep;158:109937. doi: 10.1016/j.yebeh.2024.109937. Epub 2024 Jul 13.
Epilepsy is a disease that affects a significant proportion of the female population worldwide. The management of anti-seizure medications during pregnancy and the potential adverse outcomes to both the mother and fetus represent a significant challenge. This retrospective study aimed to evaluate the impact of anti-seizure medications during pregnancy by comparing maternal and fetal outcomes between pregnant women with and without epilepsy.
A total of 242 participants were analysed, including 112 with epilepsy and 130 healthy pregnant controls. Maternal age, medical history, seizure characteristics, use of anti-seizure medications, and pregnancy history were recorded. Maternal and fetal complications, delivery modes, and perinatal outcomes were evaluated.
A total of 242 patients, including 112 (46.3 %) pregnant women with epilepsy and 130 (53.7 %) healthy pregnant women, were included in the study. Among pregnant patients with epilepsy, 4 (3.5 %) did not use anti-seizure medications, 79 (70.5 %) received monotherapy, and 29 (25.8 %) received polytherapy. The rates of pregnancy termination, spontaneous abortion, and maternal and fetal complications were significantly higher in pregnant women with epilepsy (p = 0.045, p = 0.045, p < 0.001, and p = 0.016, respectively). Folic acid use, planned pregnancy rate and postpartum breastfeeding rate were all statistically lower in pregnant women with epilepsy (p < 0.001, p < 0.001, p < 0.001, respectively). The rates of intensive care unit stay, infants with birth weight less than 2500 g, congenital malformations, and preterm births were significantly higher in babies born to pregnant women with epilepsy (p < 0.001, p = 0.047, p = 0.003, and p = 0.051, respectively). Gestational diabetes mellitus was observed in 4 (13.8 %) and congenital malformations in 4 (14.3 %) of the pregnant women with epilepsy who received polytherapy, and in both cases these rates were statistically higher than those of pregnant women with epilepsy who received monotherapy (p = 0.048 and p = 0.004, respectively).
This study demonstrated that pregnancies among women affected by epilepsy have significantly higher rates of maternal and fetal complications, spontaneous abortions, and premature births. Polytherapy with anti-seizure medications is associated with an increased risk of gestational diabetes and congenital anomalies. Notably, folic acid use, planned pregnancy, and postpartum breastfeeding were less common in patients with epilepsy. The most commonly prescribed anti-seizure medications were levetiracetam and lamotrigine. Caesarean section is a common mode of delivery in pregnancies of mothers with epilepsy.
These results suggest that epilepsy increases both maternal and fetal complications during pregnancy. Furthermore, the use of anti-seizure medications appears to have a significant impact on pregnancy outcomes. Our findings highlight the need for comprehensive management strategies and informed decision making to reduce risks and optimise maternal and fetal outcomes among women with epilepsy.
癫痫是一种影响全球相当一部分女性人口的疾病。怀孕期间抗癫痫药物的管理以及对母亲和胎儿的潜在不良后果是一个重大挑战。本回顾性研究旨在通过比较癫痫和非癫痫孕妇的母婴结局来评估怀孕期间抗癫痫药物的影响。
共分析了 242 名参与者，包括 112 名癫痫孕妇和 130 名健康孕妇对照。记录了母亲的年龄、病史、癫痫发作特征、抗癫痫药物使用情况和妊娠史。评估了母婴并发症、分娩方式和围产期结局。
共纳入 242 例患者，包括 112 例（46.3%）癫痫孕妇和 130 例（53.7%）健康孕妇。癫痫孕妇中，有 4 例（3.5%）未使用抗癫痫药物，79 例（70.5%）接受单药治疗，29 例（25.8%）接受多药治疗。癫痫孕妇的妊娠终止率、自然流产率、母婴并发症发生率显著高于非癫痫孕妇（p=0.045、p=0.045、p<0.001 和 p=0.016）。癫痫孕妇中叶酸的使用、计划妊娠率和产后母乳喂养率均明显低于非癫痫孕妇（p<0.001、p<0.001、p<0.001）。癫痫孕妇所生婴儿的重症监护病房入住率、出生体重<2500g 的婴儿比例、先天性畸形率和早产率均显著高于非癫痫孕妇（p<0.001、p=0.047、p=0.003 和 p=0.051）。接受多药治疗的癫痫孕妇中，有 4 例（13.8%）发生妊娠期糖尿病，4 例（14.3%）发生先天性畸形，这两种情况的发生率均明显高于接受单药治疗的癫痫孕妇（p=0.048 和 p=0.004）。
本研究表明，癫痫女性的妊娠母婴并发症、自然流产和早产发生率显著更高。抗癫痫药物的联合治疗与妊娠期糖尿病和先天性畸形的风险增加有关。值得注意的是，癫痫患者中叶酸的使用、计划妊娠和产后母乳喂养的比例较低。最常开的抗癫痫药物是左乙拉西坦和拉莫三嗪。癫痫孕妇的剖宫产率较高。
这些结果表明，癫痫会增加孕妇在怀孕期间的母婴并发症。此外，抗癫痫药物的使用似乎对妊娠结局有重大影响。我们的研究结果强调了需要综合管理策略和知情决策，以降低癫痫女性的母婴风险并优化母婴结局。
