The course and outcome of pregnancy and neonatal situation in epileptic women

Authors
Mohammad Reza Najafi 1
Farnoosh Sonbolestan 1
Seyed Ali Sonbolestan 2
Mohammad Zare 3
Jafar Mehvari 3
Shahrokh Noori Meshkati 4
1 Department of Neurology, Alzahra Hospital, Isfahan, Iran
2 Isfahan Neuroscience Research Center, Isfahan, Iran
3 Department of Neurology, Kashani Hospital, Isfahan, Iran
4 Anesthesiologist, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Epilepsy is a rare neurologic disorder during pregnancy. Despite its rarity, it could cause different clinical problems in this natural phenomenon of a woman's life. The aim of this study was to evaluate and compare the course of pregnancy and labor and their outcome in epileptic and healthy women.
Materials and Methods: This study was performed during years 2009--2011 in Alzahra and Beheshti hospitals affiliated to Isfahan University of Medical Sciences. A total of 51 pregnant women, who were known cases of epilepsy and were on antiepileptic drugs treatment for at least 3 months, were compared with 47 matched healthy pregnant women without epilepsy. They were followed before and during their pregnancy in several visits and all of their neurologic and obstetric information were collected. For statistical analysis of continuous variables, the t-test was used. The chi-square test was used for dichotomous variables.
Results: The rate of monotherapy was more than polytheraphy especially during the pregnancy. The epileptic attacks stopped in majority of patients during the pregnancy. Vaginal bleeding (P=0.020) and abortion (P=0.015) were significantly more frequent among epileptic mothers. The gestational age was lower meaningfully (P= 0.010) in epileptic patients' neonates and the first minute Apgar score was lower in these babies too (P=0.028).
Conclusions: Antiepileptic drugs could have some unsuitable effects on pregnancy course especially by increasing the rate of abortion, preterm labor, and vaginal bleeding. Their adverse effects on neonates' health could not be neglected.
Keywords
Anticonvulsants
epilepsy
labor
newborn
pregnancy
1. Borthen I, Eide MG, Veiby G, Daltveit AK, Gilhus NE. Complications during pregnancy in women with epilepsy: Population-based cohort study. BJOG 2009;116:1736-42.  Back to cited text no. 1
    
2. Brosh K, Matok I, Sheiner E, Koren G, Wiznitzer A, Gorodischer R, et al. Teratogenic determinants of first-trimester exposure to antiepileptic medications. J Popul Ther Clin Pharmacol 2011;18:e89-98.  Back to cited text no. 2
    
3. Fried S, Kozer E, Nulman I, Einarson TR, Koren G. Malformation rates in children of women with untreated epilepsy: A meta-analysis. Drug Saf 2004;27:197-202.  Back to cited text no. 3
    
4. Artama M, Auvinen A, Raudaskoski T, Isojärvi I, Isojärvi J. Antiepileptic drug use of women with epilepsy and congenital malformations in offspring. Neurology 2005;64:1874-8.  Back to cited text no. 4
    
5. Holmes LB, Harvey EA, Coull BA, Huntington KB, Khoshbin S, Hayes AM, et al. The teratogenicity of anticonvulsant drugs. N Engl J Med 2001;344:1132-8.  Back to cited text no. 5
    
6. Morrow J, Russell A, Guthrie E, Parsons L, Robertson I, Waddell R, et al. Malformation risks of antiepileptic drugs in pregnancy: A prospective study from the UK Epilepsy and Pregnancy Register. J Neurol Neurosurg Psychiatry 2006;77:193-8.  Back to cited text no. 6
    
7. Adab N, Kini U, Vinten J, Ayres J, Baker G, Clayton-Smith J, et al. The longer term outcome of children born to mothers with epilepsy. J Neurol Neurosurg Psychiatry 2004;75:1575-83.  Back to cited text no. 7
    
8. Meador KJ, Baker GA, Browning N, Clayton-Smith J, Combs-Cantrell DT, Cohen M, et al. Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs. N Engl J Med 2009;360:1597-605.  Back to cited text no. 8
    
9. Meador KJ. Neurodevelopmental effects of antiepileptic drugs. Curr Neurol Neurosci Rep 2002;2:373-8.  Back to cited text no. 9
    
10. Montouris G. Importance of monotherapy in women across the reproductive cycle. Neurology 2007;69(24 Suppl 3):S10-6.  Back to cited text no. 10
    
11. Pennell PB. The importance of monotherapy in pregnancy. Neurology 2003;60(11 Suppl 4):S31-8.  Back to cited text no. 11
    
12. Tomson T, Danielsson BR, Winbladh B. [Epilepsy and pregnancy. Balancing between risks to the mother and child]. Lakartidningen 1997;94:2827-32, 35.  Back to cited text no. 12
    
13. Yerby MS. The use of anticonvulsants during pregnancy. Semin Perinatol 2001;25:153-8.  Back to cited text no. 13
    
14. Steinhoff BJ. Pregnancy, epilepsy, and anticonvulsants. Dialogues Clin Neurosci 2008;10:63-75.  Back to cited text no. 14
    
15. Morrow JI, Craig JJ. Anti-epileptic drugs in pregnancy: Current safety and other issues. Expert Opin Pharmacother 2003;4:445-56.  Back to cited text no. 15
    
16. Battino D, Tomson T. Management of epilepsy during pregnancy. Drugs 2007;67:2727-46.  Back to cited text no. 16
    
17. Harden CL, Sethi NK. Epileptic disorders in pregnancy: An overview. Curr Opin Obstet Gynecol 2008;20:557-62.  Back to cited text no. 17
    
18. Nelson KB, Ellenberg JH. Maternal seizure disorder, outcome of pregnancy, and neurologic abnormalities in the children. Neurology 1982;32:1247-54.  Back to cited text no. 18
    
19. Nulman I, Laslo D, Koren G. Treatment of epilepsy in pregnancy. Drugs 1999;57:535-44.  Back to cited text no. 19
    
20. Pschirrer ER, Monga M. Seizure disorders in pregnancy. Obstet Gynecol Clin North Am 2001;28:601-11, vii.  Back to cited text no. 20
    
21. Yerby M, Koepsell T, Daling J. Pregnancy complications and outcomes in a cohort of women with epilepsy. Epilepsia 1985;26:631-5.  Back to cited text no. 21
    
22. Wilhelm J, Morris D, Hotham N. Epilepsy and pregnancy--a review of 98 pregnancies. Aust N Z J Obstet Gynaecol 1990;30:290-5.  Back to cited text no. 22
    
23. Yerby MS. Contraception, pregnancy and lactation in women with epilepsy. Baillieres Clin Neurol 1996;5:887-908.  Back to cited text no. 23
    
24. Kampman MT. Folate status in women of childbearing age with epilepsy. Epilepsy Res 2007;75:52-6.  Back to cited text no. 24
    
25. Morrell MJ. The new antiepileptic drugs and women: Efficacy, reproductive health, pregnancy, and fetal outcome. Epilepsia 1996;37 Suppl 6:S34-44.  Back to cited text no. 25
    
26. Yazdizadeh B, Nedjat S, Mohammad K, Rashidian A, Changizi N, Majdzadeh R. Cesarean section rate in Iran, multidimensional approaches for behavioral change of providers: A qualitative study. BMC Health Serv Res 2011;11:159.  Back to cited text no. 26
    
27. Meador KJ, Zupanc ML. Neurodevelopmental outcomes of children born to mothers with epilepsy. Cleve Clin J Med 2004;71 Suppl 2:S38-41.  Back to cited text no. 27
    
28. Yerby MS. Problems and management of the pregnant woman with epilepsy. Epilepsia 1987;28 Suppl 3:S29-36.  Back to cited text no. 28
    
29. Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med 2001;344:467-71.  Back to cited text no. 29
    
30. Kulaga S, Sheehy O, Zargarzadeh AH, Moussally K, Bérard A. Antiepileptic drug use during pregnancy: Perinatal outcomes. Seizure 2011;20:667-72.  Back to cited text no. 30
    
31. Adab N, Tudur SC, Vinten J, Williamson P, Winterbottom J. Common antiepileptic drugs in pregnancy in women with epilepsy. Cochrane Database Syst Rev 2004;3:CD004848.  Back to cited text no. 31
    
32. Pack AM, Reddy DS, Duncan S, Herzog A. Neuroendocrinological aspects of epilepsy: Important issues and trends in future research. Epilepsy Behav 2011;22:94-102.  Back to cited text no. 32
    
 
Advanced Biomedical Research
Volume 2012, March
March 2012
Pages 1-7