Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
Epilepsia. 2024 Sep;65(9):2599-2611. doi: 10.1111/epi.18064. Epub 2024 Jul 30.
This study was undertaken to examine the association between different patterns of antiseizure medication (ASM) use during pregnancy and adverse obstetric outcomes (preterm birth, low birth weight [LBW], and small for gestational age [SGA]).
This retrospective cohort study used the Birth Certificate Application and National Health Insurance data in Taiwan (January 1, 2004 through December 31, 2018). We retrieved weekly ASM among pregnant women with epilepsy who were prepregnancy chronic users and used group-based trajectory modeling to identify distinct patterns of use. Logistic regressions were adopted to examine the association between patterns of ASM use and risk of preterm birth, LBW, and SGA. In addition, we revealed postnatal ASM utilization pattern among these prepregnancy chronic users as an exploratory study.
Of 2175 pregnant women with epilepsy, we identified four patterns of ASM use during pregnancy: frequent and continuous (64.87%), frequent but discontinuous (7.08%), intermittent (19.72%), and intermittent and discontinuous users (8.32%). Compared to frequent and continuous users, the adjusted odds ratios for preterm birth in frequent but discontinuous, intermittent, and intermittent and discontinuous users were .83 (95% confidence interval [CI] = .47-1.48), .71 (95% CI = .47-1.05), and .88 (95% CI = .52-1.49), respectively. Similar results were observed for LBW and SGA. In the exploratory study, we found that most of our study subjects maintained the same patterns before and after delivery.
After considering duration and timing of exposure, our study did not find an association between four distinct patterns of ASM use and adverse obstetric outcomes among women with epilepsy. The findings suggested that optimal seizure control could be received for pregnant women with epilepsy after evaluating the risks and benefits.
本研究旨在探讨妊娠期间抗癫痫药物（ASM）使用模式的差异与不良产科结局（早产、低出生体重[LBW]和小于胎龄儿[SGA]）之间的关系。
本回顾性队列研究使用了台湾的出生证明申请和全民健康保险数据（2004 年 1 月 1 日至 2018 年 12 月 31 日）。我们检索了患有癫痫症的孕妇在怀孕前慢性使用 ASM 的每周使用情况，并使用基于群组的轨迹建模来识别使用的不同模式。采用逻辑回归来检验 ASM 使用模式与早产、LBW 和 SGA 风险之间的关系。此外，我们还对这些怀孕前慢性使用者的产后 ASM 利用模式进行了探索性研究。
在 2175 名患有癫痫症的孕妇中，我们确定了妊娠期间 ASM 使用的四种模式：频繁且连续（64.87%）、频繁但不连续（7.08%）、间歇性（19.72%）和间歇性和不连续使用者（8.32%）。与频繁且连续使用者相比，频繁但不连续、间歇性和间歇性不连续使用者的早产调整比值比分别为 0.83（95%置信区间[CI] = 0.47-1.48）、0.71（95% CI = 0.47-1.05）和 0.88（95% CI = 0.52-1.49）。对于 LBW 和 SGA，也观察到了类似的结果。在探索性研究中，我们发现我们的研究对象大多数在分娩前后保持相同的模式。
在考虑了暴露的持续时间和时间后，我们的研究没有发现癫痫症女性中四种不同的 ASM 使用模式与不良产科结局之间的关联。研究结果表明，在评估风险和收益后，癫痫症孕妇可以获得最佳的癫痫控制。
