medwireNews: A meta-analysis in The Lancet quantifies the risks for pregnant women associated with having epilepsy and taking antiepileptic drugs (AEDs).
The study, which included 38 studies with nearly 3 million pregnancies, found that women with epilepsy had significantly increased risks of hypertensive disorders, spontaneous miscarriage, antepartum and postpartum haemorrhage, induction of labour, caesarean section and preterm birth.
The magnitude of this risk increase was small, however, ranging from a 16% increase for preterm birth to a 67% increase for induction of labour.
Foetal and neonatal mortality were not influenced by the presence of epilepsy, with the only foetal or neonatal outcome significantly affected being foetal growth restriction, at a 26% risk increase.
“On the basis of our findings, women with epilepsy, and those given antiepileptic drugs, should be informed that a small but significant risk of obstetric complications can occur”, comment Javier Zamora (Hospital Ramón y Cajal, Madrid, Spain) and co-researchers.
“Regular monitoring of pregnant women with epilepsy in the antenatal period is essential for early detection of hypertensive disorders and growth-restricted fetuses.”
Taking AEDs versus no epilepsy medication was associated with significantly increased risks of postpartum haemorrhage and induction of labour in women, and of foetal growth restriction and admission to the neonatal intensive care unit in their babies. Foetal growth restriction was the only outcome with a markedly increased risk, at 3.51-fold, although the 95% confidence interval was wide.
The team also found an increased risk of caesarean section associated with AED polytherapy versus monotherapy, but note that epilepsy and its treatment per se may not fully account for this association or for that with induced labour.
“Many other factors such as the perception of epilepsy as a chronic disease, uncertainty in management, an increase in rates of antepartum haemorrhage, hypertensive disorders and fetal growth restriction, and a low threshold for intervention might have contributed to this rise”, they say.
The researchers say that more studies are needed to address other factors such as the effects of seizure control, and of specific AEDs and doses.
In a linked commentary, Kimford Meador (Stanford University School of Medicine, California, USA) reiterates this point, and adds: “Furthermore, these studies need to address the risks of antiepileptic drug treatment during pregnancy in women without epilepsy, because more than half of antiepileptic drug prescriptions are for disorders other than epilepsy (eg, pain and psychiatric symptoms).”
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