Spontaneous fetal loss in women with epilepsy: prospective data from pregnancy registry in India

Trivedi, Madhukar H.; Jose, Manna; Philip, Rini M.; Sarma, P. Sankara; Thomas, Sanjeev V

doi:10.1016/j.eplepsyres.2018.07.016

Cited by 7 publications

(8 citation statements)

References 13 publications

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“…Healthy, non‐exposed pregnant women were used as a control group in this analysis. The rate of fetal/perinatal death reported in the studies 38–40 was 5.26–13.2% for monotherapy oxcarbazepine exposure. All of the studies were considered to have a low risk of bias according to NOS (Table S4 in the Supporting Information).…”

Section: Discussionmentioning

confidence: 97%

“…We included 19 cohort studies, 16,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] of which 16 (84.2%) were prospective and three (15.8%) were retrospective published between 1991 and 2021. The majority of the studies were based in Europe (11/19, 57.9%), followed by North America (3/19, 15.8%), Asia (2/19, 10.5%), Oceania (2/19, 10.5%) and South America (1/19, 5.3%).…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…We performed sensitivity analysis by excluding two studies with a high risk of bias from this meta-analysis. 39,41 The summary OR was 2.47 (95% CI, 1.19-5.13) (test for overall effect: Z = 2.42, P = .02).…”

Section: Sensitivity Analysismentioning

confidence: 99%

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Adverse fetal and neonatal outcomes following in‐utero exposure to oxcarbazepine: A systematic review and meta‐analysis

Athar

Ehsan

Farooq

et al. 2022

Brit J Clinical Pharma

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This systematic review aims to assess the safety profile of oxcarbazepine during pregnancy.Methods: Observational studies that included women who took oxcarbazepine anytime during pregnancy were included in our systematic review. The review did not include non-English articles, reviews, meta-analyses, case reports and animal studies.Different online sources such as MEDLINE, Cochrane library, Virtual Health Library, etc., were searched for published and unpublished literature. Assessment of the risk of bias in observational studies was carried out using the Newcastle-Ottawa Scale.The meta-analyses were performed using a random-effect model. GRADE was used for the evaluation of the quality of evidence for the primary outcomes.Results: We included 19 cohort studies with a total of 5 071 137 patients, of which 2450 were exposed to oxcarbazepine either as monotherapy or polytherapy. The summary odds ratio (OR) was 1.69 (95% CI, 0.95-2.98) for congenital malformations following in-utero exposure to oxcarbazepine as compared to the control group of unexposed patients (seven studies [n = 625]), and was 1.19 (95% CI, 0.67-2.12) when compared to those following lamotrigine (LTG) exposure during pregnancy (3 studies [n = 591]). In total, three studies (n = 770) reported the association between in-utero oxcarbazepine exposure and fetal/perinatal deaths. The metaanalysis yielded a summary OR of 3.33 (95% CI, 1.70-6.51). Conclusion:Our systematic review will help healthcare providers and guideline developers regarding the treatment of epilepsy and other neurological disorders during pregnancy. More cohort studies with a higher sample size concerning oxcarbazepine use in pregnant patients are required to truly assess the in-utero safety profile of the drug.

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Section: Discussionmentioning

confidence: 97%

Section: Study and Patient Characteristicsmentioning

confidence: 99%

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Adverse fetal and neonatal outcomes following in‐utero exposure to oxcarbazepine: A systematic review and meta‐analysis

Athar

Ehsan

Farooq

et al. 2022

Brit J Clinical Pharma

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“…[6][7][8][9] Studies investigating drug-specific effects have also reported inconsistent results. [10][11][12] Research in this area is hampered by methodological challenges, particularly the difficulty of separating any potential effects of ASMs from those related to the underlying condition requiring treatment (confounding by indication). Furthermore, as ASMs are not widely used in the general population, many studies have lacked adequate power to investigate the risks associated with specific ASMs.…”

Section: General Neurologymentioning

confidence: 99%

First-trimester use of antiseizure medications and the risk of miscarriage: a population-based cohort study

Forbes,

Madley-Dowd,

Ahlqvist

et al. 2024

J Neurol Neurosurg Psychiatry

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BackgroundAntiseizure medications (ASMs) during the first trimester of pregnancy have been associated with an increased risk of miscarriage.MethodsWe carried out a population-based cohort study using routinely collected healthcare data from the UK, 1995–2018. Pregnancies were identified in the Clinical Practice Research Datalink and we estimated the HR of miscarriage associated with prescriptions of ASMs during the first trimester of pregnancy, using Cox regression, adjusting for potential confounders, including ASM indications.ResultsASMs were prescribed during the first trimester in 7832 (0.8%) of 1 023 787 included pregnancies. 14.5% of pregnancies with first-trimester exposure to ASMs ended in miscarriage, while 12.2% without ASM exposure in the first trimester ended in miscarriage; after adjustment, there was a 1.06-fold relative hazard of miscarriage (95% CI 1.00 to 1.13) in women with first-trimester ASM use. After restricting to women with specific ASM indications, this association was not evident in women with epilepsy (adjusted HR 0.98, 95% CI 0.89 to 1.08), but was observed in women with bipolar or other psychiatric conditions (1.08, 95% CI 1.00 to 1.16) although CIs overlapped. Compared with discontinuation of ASMs prior to pregnancy, there was no evidence of increased risk of miscarriage for first-trimester ASM use in women with bipolar or other psychiatric conditions (1.02, 95% CI 0.87 to 1.20).ConclusionWe found no clear evidence to suggest that first-trimester ASM use increased the risk of miscarriage. Taken together, our analyses suggest that apparent associations between first-trimester ASM use and miscarriage may be the result of confounding by the presence of a bipolar disorder or associated unmeasured variables.

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“…2 Women with epilepsy (WWE) are at increased risk of menstrual disorders like polycystic ovarian syndrome, spontaneous fetal loss, and congenital fetal malformations. [3][4][5] Contraceptive advice for ensuring safe pregnancies among WWE, particularly with respect to hormonal contraceptive use, is challenging. 6 However, the existing guidelines for management of WWE do not cover all important areas.…”

Section: Introductionmentioning

confidence: 99%

Reproductive Health of Women with Epilepsy in India: An Observational Study

Kumar,

Aghoram,

Keepanasseril

et al. 2022

International Journal of Epilepsy

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Objectives Women with epilepsy (WWE) have special reproductive health needs. We compare menstrual disorders, obstetric outcomes, and patterns of contraceptive use among WWE in the reproductive age group to those without epilepsy. Methods Sixty WWE between the ages of 18 and 45 years were randomly selected from a hospital database, and 60 controls in the same age group were recruited from among their families or close contacts. A questionnaire adapted from the National Family Health Survey 5 (NFHS-5) was administered to collect data on menstrual patterns, obstetric outcomes, fertility preferences, and contraceptive use. Descriptive statistics were used. Graphical and cross-tabulations were used for comparisons. All statistics were performed on STATA version 14.2 (StataCorp, Texas, United States). Results The demographic characteristics including mean age, education, and occupational status were comparable. Dysmenorrhea requiring use of pain killers was more common among WWE (odds ratio [OR]: 3.01; 95% confidence interval [CI]: 1.11–8.72); other menstrual disorders were equally frequent. Spontaneous fetal loss was seen in 25 (21.9%) of 114 pregnancies in WWE and 22 (17.9%) of 123 among control women. Demand for family planning was satisfied in 21 (65.6%) of 32 eligible WWE and 23 (62.2%) of 37 controls with the most common method being female sterilization. WWE knew fewer methods of contraception compared with controls (median: 2; interquartile range [IQR]: 1.2 vs. 4; IQR: 2.5; p < 0.0001). Conclusion WWE had more dysmenorrhea and less knowledge of contraceptive methods compared with controls. Abnormal uterine bleeding, contraceptive use, and spontaneous fetal loss were similar in both groups.

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Spontaneous fetal loss in women with epilepsy: prospective data from pregnancy registry in India

Cited by 7 publications

References 13 publications

Adverse fetal and neonatal outcomes following in‐utero exposure to oxcarbazepine: A systematic review and meta‐analysis

Adverse fetal and neonatal outcomes following in‐utero exposure to oxcarbazepine: A systematic review and meta‐analysis

First-trimester use of antiseizure medications and the risk of miscarriage: a population-based cohort study

Reproductive Health of Women with Epilepsy in India: An Observational Study

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