Maternal deaths with epilepsy: A population-based study in Turkey

Yücel, Aykan; Atalay, Funda; Altınboğa, Orhan; Koksal, Zuhal; Baydilli, Meltem Buz; Esen, Meral; Karabacak, Yurdum; Ongun, Veli; Şahlar, Tuba Esra; Keskinkılıç, Bekir; Kara, Fatih

doi:10.1016/j.ejogrb.2020.12.045

Cited by 3 publications

(9 citation statements)

References 13 publications

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“…In particular, causes of maternal mortality in people with epilepsy have been investigated given concern for sudden unexpected death in epilepsy (SUDEP), which occurs without apparent cause and regardless of pregnancy state or seizure control. Studies from Japan and Turkey both found that SUDEP was a leading cause for maternal deaths [13 ▪ ,15 ▪ ]. SUDEP was also associated with a longer duration of epilepsy and longer time interval between last seizure and pregnancy [13 ▪ ].…”

Section: Antepartum Considerations In People With Epilepsymentioning

confidence: 99%

“…Studies from Japan and Turkey both found that SUDEP was a leading cause for maternal deaths [13 ▪ ,15 ▪ ]. SUDEP was also associated with a longer duration of epilepsy and longer time interval between last seizure and pregnancy [13 ▪ ]. In maternal deaths in people with epilepsy wherein a cause was identified, leading reasons were pulmonary embolism (32%), cerebrovascular event (23%) and cerebral vein thrombosis (15%) [13 ▪ ].…”

Section: Antepartum Considerations In People With Epilepsymentioning

confidence: 99%

“…Although the majority of pregnancies in people with epilepsy result in normal, uncomplicated births, they are considered high risk pregnancies due to increased obstetric and foetal risks. Prior literature shows that people with epilepsy are at a higher risk for spontaneous abortion, antepartum haemorrhage, postpartum haemorrhage, gestational hypertension, preeclampsia, induction of labour, caesarean delivery, congenital malformations, preterm birth, foetal death, severe maternal morbidity (SMM) and maternal mortality during pregnancy [1 ▪▪ ,6 ▪▪ ,11,12 ▪▪ ,13 ▪ ]. The increase in risk for these complications remain relatively small, approximately 1 to 1.7-fold with the exception of maternal mortality, which has an increased risk up to 10-fold [14 ▪ ].…”

Section: Antepartum Considerations In People With Epilepsymentioning

confidence: 99%

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Contemporary management of epilepsy in pregnancy

Darmawan¹,

Panelli

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewThe number of reproductive aged people with epilepsy in the United States is increasing, making epilepsy during pregnancy more prevalent. Simultaneously, more people are using newer generations of antiseizure medications before, during and after pregnancy. Here, we review current evidence on contemporary management and outcomes of pregnancies among people with epilepsy. Recent findingsThis review evaluates recent literature to summarize current practices in preconception counselling, contraception, antiseizure medications before, during and after pregnancy, and peri-partum and postpartum risks in people with epilepsy.

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Section: Antepartum Considerations In People With Epilepsymentioning

confidence: 99%

Section: Antepartum Considerations In People With Epilepsymentioning

confidence: 99%

Section: Antepartum Considerations In People With Epilepsymentioning

confidence: 99%

See 1 more Smart Citation

Contemporary management of epilepsy in pregnancy

Darmawan¹,

Panelli

2022

Current Opinion in Obstetrics &Amp; Gynecology

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“…3 In a Turkish population-based study, pulmonary embolism, cerebrovascular event, and cerebral vein thrombosis were attributed as the cause of death in maternal deaths that are accompanied by epilepsy. 4 Medications used for the treatment of SRSE include benzodiazepines (BZDs), antiepileptic drugs (AEDs), and IVADs, often used simultaneously. There are no guidelines providing specific recommendations for the treatment of SRSE.…”

Section: Introductionmentioning

confidence: 99%

“…3 In a Turkish population–based study, pulmonary embolism, cerebrovascular event, and cerebral vein thrombosis were attributed as the cause of death in maternal deaths that are accompanied by epilepsy. 4…”

Section: Introductionmentioning

confidence: 99%

Super-refractory status epilepticus in a 29-year-old pregnant female

Carrasco

Schwalk

Hwang

et al. 2021

SAGE Open Medical Case Reports

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Super-refractory status epilepticus is a rare medical and neurological emergency due to the high mortality and morbidity associated with this condition. Furthermore, there is very little data regarding its incidence, etiology, and management in the pregnant population with super-refractory status epilepticus. The treatment of super-refractory status epilepticus during pregnancy is specifically a major challenge as there are limited available therapeutic options due to the well-established teratogenicity of most antiepileptic drugs and the unknown safety profile of some of the anesthetics commonly used for seizure control. We report a case of successfully treated super-refractory status epilepticus in a 29-year-old, 26 weeks pregnant female who after an emergent delivery and prolonged exposure to multiple antiepileptic drugs recovered full neurological function.

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The impact of epilepsy and antiseizure medications on pregnancy and neonatal outcomes: A nationwide cohort study

Kuo,

See

et al. 2023

Brain and Behavior

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PurposeOur objective was to assess the adverse outcomes during pregnancy, as well as for the fetus and neonates, in women with epilepsy, both with and without the use of antiseizure medications (ASMs).MethodsA cohort of singleton pregnancies between January 1, 2004 and December 31, 2014 was identified using the Taiwan National Health Database. The pregnancies were categorized into ASM exposure, ASM nonexposure, and control (consisting of women without an epilepsy diagnosis) groups. We recorded adverse outcomes in neonates and documented pregnancy complications. The generalized estimating equation with logit link was used to estimate adjusted odds ratios.ResultsThere were 629 singleton pregnancies in the group exposed to ASMs, 771 in the epilepsy group without ASM exposure, and 2,004,479 in the control group. Women with epilepsy had a significantly higher risk of puerperal cerebrovascular diseases (adjusted odds ratios in the exposure and nonexposure groups = 54.46 and 20.37, respectively), respiratory distress syndrome (5.1 and 2.99), mortality (3.15 and 3.22), sepsis (2.67 and 2.54), pregnancy‐related hypertension (1.71 and 1.8), preeclampsia (1.87 and 1.79), cesarean delivery (1.72 and 2.15), and preterm labor (1.38 and 1.56). The use of ASMs may increase the risk of eclampsia (adjusted odds ratio = 12.27). Compared to controls, fetuses/neonates born to women with epilepsy had a higher risk of unexplained stillbirth (adjusted odds ratios in the exposure and nonexposure groups = 2.51 and 2.37, respectively), congenital anomaly (1.37 and 1.33), central nervous system malformation (3.57 and 2.25), low birth weight (1.90 and 1.97), and a low Apgar score at 5 min (2.63 and 1.3). The use of ASMs may introduce an additional risk of small for gestational age; the adjusted odds ratio was 1.51.ConclusionWomen with epilepsy, irrespective of their exposure to ASMs, had a slightly elevated risk of pregnancy and perinatal complications. Puerperal cerebrovascular diseases may be a hidden risk for women with epilepsy.

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Maternal deaths with epilepsy: A population-based study in Turkey

Cited by 3 publications

References 13 publications

Contemporary management of epilepsy in pregnancy

Contemporary management of epilepsy in pregnancy

Super-refractory status epilepticus in a 29-year-old pregnant female

The impact of epilepsy and antiseizure medications on pregnancy and neonatal outcomes: A nationwide cohort study

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