Authors
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
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. |
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. |
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. |
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. |
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. |
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. |
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. |
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. |
9. | Meador KJ. Neurodevelopmental effects of antiepileptic drugs. Curr Neurol Neurosci Rep 2002;2:373-8. |
10. | Montouris G. Importance of monotherapy in women across the reproductive cycle. Neurology 2007;69(24 Suppl 3):S10-6. |
11. | Pennell PB. The importance of monotherapy in pregnancy. Neurology 2003;60(11 Suppl 4):S31-8. |
12. | Tomson T, Danielsson BR, Winbladh B. [Epilepsy and pregnancy. Balancing between risks to the mother and child]. Lakartidningen 1997;94:2827-32, 35. |
13. | Yerby MS. The use of anticonvulsants during pregnancy. Semin Perinatol 2001;25:153-8. |
14. | Steinhoff BJ. Pregnancy, epilepsy, and anticonvulsants. Dialogues Clin Neurosci 2008;10:63-75. |
15. | Morrow JI, Craig JJ. Anti-epileptic drugs in pregnancy: Current safety and other issues. Expert Opin Pharmacother 2003;4:445-56. |
16. | Battino D, Tomson T. Management of epilepsy during pregnancy. Drugs 2007;67:2727-46. |
17. | Harden CL, Sethi NK. Epileptic disorders in pregnancy: An overview. Curr Opin Obstet Gynecol 2008;20:557-62. |
18. | Nelson KB, Ellenberg JH. Maternal seizure disorder, outcome of pregnancy, and neurologic abnormalities in the children. Neurology 1982;32:1247-54. |
19. | Nulman I, Laslo D, Koren G. Treatment of epilepsy in pregnancy. Drugs 1999;57:535-44. |
20. | Pschirrer ER, Monga M. Seizure disorders in pregnancy. Obstet Gynecol Clin North Am 2001;28:601-11, vii. |
21. | Yerby M, Koepsell T, Daling J. Pregnancy complications and outcomes in a cohort of women with epilepsy. Epilepsia 1985;26:631-5. |
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. |
23. | Yerby MS. Contraception, pregnancy and lactation in women with epilepsy. Baillieres Clin Neurol 1996;5:887-908. |
24. | Kampman MT. Folate status in women of childbearing age with epilepsy. Epilepsy Res 2007;75:52-6. |
25. | Morrell MJ. The new antiepileptic drugs and women: Efficacy, reproductive health, pregnancy, and fetal outcome. Epilepsia 1996;37 Suppl 6:S34-44. |
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. |
27. | Meador KJ, Zupanc ML. Neurodevelopmental outcomes of children born to mothers with epilepsy. Cleve Clin J Med 2004;71 Suppl 2:S38-41. |
28. | Yerby MS. Problems and management of the pregnant woman with epilepsy. Epilepsia 1987;28 Suppl 3:S29-36. |
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. |
30. | Kulaga S, Sheehy O, Zargarzadeh AH, Moussally K, Bérard A. Antiepileptic drug use during pregnancy: Perinatal outcomes. Seizure 2011;20:667-72. |
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. |
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. |