Pregnant women with epilepsy experience worse perinatal outcomes


Recent research findings published in JAMA Neurology suggest that pregnant women with epilepsy may be more prone to develop maternal and fetal problems.

In order to enhance pregnancy outcomes for women with epilepsy and their offspring, experts emphasized that adequate prenatal planning and management are crucial. This is because knowing one’s pregnancy risks can aid one’s treatment plan and lessen undesirable consequences, such as congenital abnormalities.

Exposure to medicines for epilepsy (ASMs), the main treatment for the neurological disease, is a substantial risk associated with maternal epilepsy. According to earlier studies, women with epilepsy who were exposed to ASMs were more likely to have perinatal hazards, such as maternal mortality and premature birth.

The researchers conducted a systematic review and meta-analysis of studies registered in the Ovid MEDLINE, Embase, CINAHL, and PsycINFO databases from the beginning through December 6, 2022 to further evaluate perinatal outcomes (from conception to one year postpartum) for women with epilepsy compared to women without epilepsy.

In addition to manual journal searches, OpenGrey, Google Scholar, and reference lists from related works, searches are also conducted. The relationships between ASM exposure and epilepsy were also looked at, including comparisons between women with epilepsy using ASM and women without epilepsy, between women with epilepsy using ASM and those who are not using ASM, and between women with epilepsy using polytherapy ASM in comparison to monotherapy ASM.

Several outcomes for the mother, fetus, and newborn were evaluated:

Preterm birth, induced labor, gestational diabetes, intrauterine growth restriction, antepartum hemorrhage, preeclampsia, miscarriage, stillbirth, gestational hypertension, pregnancy loss, postpartum hemorrhage, placental abruption, fetal distress, maternal death, bleeding during pregnancy, preterm rupture of the membranes, eclampsia, placenta previa, induced abortion, and assisted delivery are (forceps or vacuum extraction)
Birth weight less than 2500 g, admission to the neonatal intensive care unit (NICU), tiny for gestational age, neonatal and infant mortality are all outcomes for newborns. Large for gestational age, 1 minute Apgar score less than 8, moderate birth weight, mean height, mean 1 minute Apgar score, mean 5 minute Apgar score, mean head circumference, and mean gestational age are all characteristics of healthy infants.
Congenital conditions that resulted in significant or mild structural abnormalities, such as those of the nervous system, eye, face, and heart, were evaluated whether or not they had a known genetic abnormality.

A total of 76 articles from the 8313 found were included in the meta-analyses, including 9 case-control studies, 45 retrospective cohort studies, 21 prospective cohort studies, and 1 cross-sectional study.

The results demonstrated that, when compared to women without epilepsy, women with epilepsy had an increased risk of miscarriage (odds ratio [OR], 1.62; 95% CI, 1.15-2.29; 12 articles, 25,478 pregnancies), stillbirth (OR, 1.37; 95% CI, 1.29-1.47; 20 articles, 28,134,229 pregnancies), preterm birth (OR, 1.41; 95% CI, 1, 32-1.

In addition, newborns born to women with epilepsy had an increased risk of congenital disorders (OR, 1.88; 95% CI, 1.66-2.12; 29 articles, 24,238,334 pregnancies), NICU admission (OR, 1 .99; 95% CI, 1.58-2.51; 8 articles, 1,204,428 pregnancies), and neonatal or infant mortality (OR, 1.87; 95% CI, 1.56-2.24; 13 articles, 1,426,692 pregnancies).

When compared to women without epilepsy, women with epilepsy who use ASM versus those who don’t, and women with epilepsy receiving ASM polytherapy versus ASM-monotherapy, it was discovered that the usage of ASM increased the probability of having a bad perinatal outcome.

Researchers noted that future research should try to account for potentially confounding factors for which they could not adjust, such as severity or type of epilepsy, mother’s age, deprivation, parity, and smoking status. This is because analyses were not adjusted for differences in individual study characteristics and adjustments in statistical analyses.

Our findings “support the UK national guideline that women with pre-pregnancy epilepsy should receive counseling at the time of epilepsy diagnosis and on a regular basis throughout treatment, including preconception counseling on the risk of ASM use in pregnancy for the offspring,” the researchers write in their conclusion.

Moreover, a complex care route is most suited for women with epilepsy during pregnancy and childbirth, and recommendations for using ASM during pregnancy should come from an epilepsy specialist.


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