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Association Between Pregnancy and Perinatal Outcomes Among Women With Epilepsy
Karolinska Univ Hosp, Karolinska Inst, Clin Epidemiol Unit, Dept Med Solna, SE-17176 Stockholm, Sweden..
Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Obstetrisk forskning)
Karolinska Univ Hosp, Karolinska Inst, Clin Epidemiol Unit, Dept Med Solna, SE-17176 Stockholm, Sweden..
2017 (English)In: JAMA Neurology, ISSN 2168-6149, E-ISSN 2168-6157, Vol. 74, no 8, p. 983-991Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE To date, few attempts have been made to examine associations between exposure to maternal epilepsy with or without antiepileptic drug (AED) therapy and pregnancy and perinatal outcomes.

OBJECTIVES To investigate associations between epilepsy in pregnancy and risks of pregnancy and perinatal outcomes as well as whether use of AEDs influenced risks.

DESIGN, SETTING, AND PARTICIPANTS A population-based cohort study was conducted on all singleton births at 22 or more completed gestational weeks in Sweden from 1997 through 2011; of these, 1 424 279 were included in the sample. Information on AED exposure was available in the subset of offspring from July 1, 2005, to December 31, 2011. Data analysis was performed from October 1, 2016, to February 15, 2017.

MAIN OUTCOMES AND MEASURES Pregnancy, delivery, and perinatal outcomes. Multivariable Poisson log-linear regression was used to estimate adjusted risk ratios (aRRs) and 95% CIs, after adjusting for maternal age, country of origin, educational level, cohabitation with a partner, height, early pregnancy body mass index, smoking, year of delivery, maternal pregestational diabetes, hypertension, and psychiatric disorders.

RESULTS Of the 1 429 652 births included in the sample, 5373 births were in 3586 women with epilepsy; mean (SD) age at first delivery of the epilepsy cohort was 30.54 (5.18) years. Compared with pregnancies of women without epilepsy, women with epilepsy were at increased risks of adverse pregnancy and delivery outcomes, including preeclampsia (aRR 1.24; 95% CI, 1.07-1.43), infection (aRR, 1.85; 95% CI, 1.43-2.29), placental abruption (aRR, 1.68; 95% CI, 1.18-2.38), induction (aRR, 1.31; 95% CI, 1.21-1.40), elective cesarean section (aRR, 1.58; 95% CI, 1.45-1.71), and emergency cesarean section (aRR, 1.09; 95% CI, 1.00-1.20). Infants of mothers with epilepsy were at increased risks of stillbirth (aRR, 1.55; 95% CI, 1.05-2.30), having both medically indicated (aRR, 1.24; 95% CI, 1.08-1.43) and spontaneous (aRR, 1.34; 95% CI, 1.20-1.53) preterm birth, being small for gestational age at birth (aRR, 1.25; 95% CI, 1.13-1.30), and having neonatal infections (aRR, 1.42; 95% CI, 1.17-1.73), any congenital malformation (aRR, 1.48; 95% CI, 1.35-1.62), major malformations (aRR, 1.61; 95% CI, 1.43-1.81), asphyxia-related complications (aRR, 1.75; 95% CI, 1.26-2.42), Apgar score of 4 to 6 at 5 minutes (aRR, 1.34; 95% CI, 1.03-1.76), Apgar score of 0 to 3 at 5 minutes (aRR, 2.42; 95% CI, 1.62-3.61), neonatal hypoglycemia (aRR, 1.53; 95% CI, 1.34-1.75), and respiratory distress syndrome (aRR, 1.48; 95% CI, 1.30-1.68) compared with infants of unaffected women. In women with epilepsy, using AEDs during pregnancy did not increase the risks of pregnancy and perinatal complications, except for a higher rate of induction of labor (aRR, 1.30; 95% CI, 1.10-1.55).

CONCLUSIONS AND RELEVANCE Epilepsy during pregnancy is associated with increased risks of adverse pregnancy and perinatal outcomes. However, AED use during pregnancy is generally not associated with adverse outcomes.

Place, publisher, year, edition, pages
AMER MEDICAL ASSOC , 2017. Vol. 74, no 8, p. 983-991
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-334323DOI: 10.1001/jamaneurol.2017.1310ISI: 000407688300019PubMedID: 28672292OAI: oai:DiVA.org:uu-334323DiVA, id: diva2:1159259
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0073Swedish Research Council, 2014-3561Available from: 2017-11-22 Created: 2017-11-22 Last updated: 2017-11-22Bibliographically approved

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