Neurological Disorders

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

Eide

Daltveit

et al. 2011

Objective To report the complications during pregnancy and delivery in women with epilepsy, compared with a control group without epilepsy, with special focus on potential risk factors, such as epilepsy severity and dosage of antiepileptic drugs.Design Hospital-based retrospective study.Setting Data from pregnancy notification forms and hospital case records.Population Women with a past or present history of epilepsy (n = 205) delivered in Bergen, Norway, in the period 1999-2006, and a matched control group of women (n = 205) without epilepsy.Methods Data were compared and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by multiple logistic regression models.Main outcome measures Pre-eclampsia (mild and severe), gestational hypertension, vaginal bleeding (early and late), caesarean section, vaginal operative delivery, postpartum haemorrhage and major malformations.Results Women with epilepsy using antiepileptic drugs had an increased risk of severe pre-eclampsia (OR, 5.0; 95% CI, 1.3-19.9), bleeding in early pregnancy (OR, 6.4; 95% CI, 2.7-15.2), induction (OR, 2.3; 95% CI, 1.2-4.3) and caesarean section (OR, 2.5; 95% CI, 1.4-4.7) adjusted for maternal age, parity, education, smoking, medical conditions and body mass index ‡30 kg/m 2 . There was also an increased risk of malformations in the offspring (OR, 7.1; 95% CI, 1.4-36.6). Women without antiepileptic drug use had increased risks of forceps delivery and preterm birth. Active epilepsy (seizures during the last 5 years) versus nonactive epilepsy did not discriminate for any of these complications; 84.5% of women with epilepsy and antiepileptic drug use were using folate.Conclusion Women with epilepsy using antiepileptic drugs had an increased risk of pregnancy and delivery complications, whereas women not using antiepileptic drugs had few complications. Seizures, high doses of antiepileptic drugs, obesity and lack of folate could not explain these increased risks.Keywords Antiepileptic drugs, delivery, epilepsy, pregnancy.Please cite this paper as: Borthen I, Eide M, Daltveit A, Gilhus N. Obstetric outcome in women with epilepsy: a hospital-based, retrospective study. BJOG 2011;118:956-965.

Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Obstetric outcome in women with epilepsy: a hospital-based, retrospective study

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

Eide

Daltveit

et al. 2011

“…Most chronic disorders increase the likelihood of CS 26 . Epilepsy represents a significant disorder, but is not an indication for CS unless either a seizure occurs during the second stage of labour or the patient cannot cooperate during a vaginal delivery 13 . The risk of seizures increases around the time of delivery 27 .…”

Section: Discussionmentioning

confidence: 99%

“…Bleeding in late pregnancy is reported to be a risk factor in women with epilepsy and the use of AEDs 2 . Folate deficiency and alteration in the metabolism of vitamin K induced by AEDs have been postulated as a possible cause 13 . Only a few studies have evaluated the effect of epilepsy on postpartum haemorrhage, and the results are conflicting.…”

Section: Introductionmentioning

confidence: 99%

Delivery outcome of women with epilepsy:a population‐based cohort study

Eide

Daltveit

et al. 2010

BJOG

Please cite this paper as: Borthen I, Eide M, Daltveit A, Gilhus N. Delivery outcome of women with epilepsy: a population‐based cohort study. BJOG 2010;117:1537–1543. Objective To investigate whether women with epilepsy have increased risks of complications during labour, and to explore the impact of antiepileptic drug use. Design Population‐based cohort study. Setting Data from the Medical Birth Registry of Norway 1999–2005. Population All births (n = 372 128) delivered in Norway, ensured through linkage with the National Population Registry run by Statistics Norway. All singleton births and the first child in multiple pregnancies were included, leaving 365 107 pregnancies for analysis. Methods Data from the Medical Birth Registry of Norway 1999–2005 were analysed. Main outcome measures Induction, caesarean section, use of forceps and vacuum, abnormal presentation, placental abruption, mechanical disproportion, postpartum haemorrhage, atony and Apgar score < 7 after 5 minutes. Results We compared 2805 pregnancies in women with a current or past history of epilepsy (0.8%) and 362 302 pregnancies in women without a history of epilepsy. Antiepileptic drugs were used in 33.6% (n = 942) of pregnant women with epilepsy. Women with epilepsy had an increased risk of induction [odds ratio (OR), 1.3; 95% confidence interval (CI), 1.1–1.4], caesarean section (OR, 1.4; 95% CI, 1.3–1.6) and postpartum haemorrhage (OR, 1.2; 95% CI, 1.1–1.4) compared with women without epilepsy. These rates were even higher for women with epilepsy and antiepileptic drug use, with ORs (95% CIs) of 1.6 (1.4–1.9), 1.6 (1.4–1.9) and 1.5 (1.3–1.9), respectively. In addition, the risk of an Apgar score < 7 was higher (OR, 1.6; 95% CI, 1.1–2.4). For women with epilepsy without antiepileptic drug use, only a slightly increased risk of caesarean delivery was observed and no increased risk for any other complications studied. Conclusions Pregnant women with epilepsy have a low complication rate; however, they have a slightly increased risk of induction, caesarean section and postpartum haemorrhage. It is not possible to ascertain on the basis of this study whether this is a result of more severe epilepsy or antiepileptic drug use.

“…However, most chronic disorders increase the likelihood of CD [66]. Epilepsy represents a significant disorder, but is not an indication for CD unless either a seizure occurs during the second stage of labor or the patient cannot cooperate during a vaginal delivery [67]. Uncertainty, together with misperception of an increased complication risk, may account for the high rates.…”

Section: Delivery Outcomementioning

confidence: 99%

Maternal epilepsy and adverse pregnancy outcomes

Expert Review of Obstetrics & Gynecology

Gilhus

2010

Epilepsy is a common neurological disorder affecting 0.3-0.7% of pregnant women. Women with epilepsy have increased maternal risks compared with the general population. Preeclampsia, gestational hypertension, bleeding in pregnancy, induction of labor, cesarean delivery and major congenital malformations of the children occur more frequently in this group. It has been unclear whether the increased risk of complications is due to the epilepsy per se, the use of antiepileptic drugs, or the combination of both factors. Recent studies have focused on the potential effects of antiepileptic drugs on adverse outcomes in pregnancy. Valproate is the medication most severely affecting the outcome. Folic acid supplementation is recommended to avoid fetal adverse outcome. In this article, principles of guidance in pregnancy and delivery are discussed, with emphasis on the obstetrical provider.