The frequency of neonatal morbidity after exposure to antiepileptic drugs in utero

Burja, Silva; Rakovec-Felser, Zlatka; Treiber, Milena; Hajdinjak, Dušanka; Gajšek-Marchetti, Marijana

doi:10.1007/s00508-006-0539-8

Cited by 8 publications

(8 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There were 45 retrospective and 21 prospective cohort studies, 9 case-control studies, and 1 cross-sectional study . Sixty-two articles had a low risk of bias and 14 a high risk of bias (eTable 2 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

Comparison of Perinatal Outcomes for Women With and Without Epilepsy

et al. 2023

View full text Add to dashboard Cite

ImportancePregnant women who have epilepsy need adequate engagement, information, and pregnancy planning and management to improve pregnancy outcomes.ObjectiveTo investigate perinatal outcomes in women with epilepsy compared with women without epilepsy.Data SourcesOvid MEDLINE, Embase, CINAHL, and PsycINFO were searched with no language or date restrictions (database inception through December 6, 2022). Searches also included OpenGrey and Google Scholar and manual searching in journals and reference lists of included studies.Study SelectionAll observational studies comparing women with and without epilepsy were included.Data Extraction and SynthesisThe PRISMA checklist was used for abstracting data and the Newcastle-Ottawa Scale for risk-of-bias assessment. Data extraction and risk-of-bias assessment were done independently by 2 authors with mediation conducted independently by a third author. Pooled unadjusted odds ratios (OR) or mean differences were reported with 95% CI from random-effects (I2 heterogeneity statistic &gt;50%) or fixed-effects (I2 &lt; 50%) meta-analyses.Main Outcomes and MeasuresMaternal, fetal, and neonatal complications.ResultsOf 8313 articles identified, 76 were included in the meta-analyses. Women with epilepsy had increased odds of miscarriage (12 articles, 25 478 pregnancies; OR, 1.62; 95% CI, 1.15-2.29), stillbirth (20 articles, 28 134 229 pregnancies; OR, 1.37; 95% CI, 1.29-1.47), preterm birth (37 articles, 29 268 866 pregnancies; OR, 1.41; 95% CI, 1.32-1.51) and maternal death (4 articles, 23 288 083 pregnancies; OR, 5.00; 95% CI, 1.38-18.04). Neonates born to women with epilepsy had increased odds of congenital conditions (29 articles, 24 238 334 pregnancies; OR, 1.88; 95% CI, 1.66-2.12), neonatal intensive care unit admission (8 articles, 1 204 428 pregnancies; OR, 1.99; 95% CI, 1.58-2.51), and neonatal or infant death (13 articles, 1 426 692 pregnancies; OR, 1.87; 95% CI, 1.56-2.24). The increased odds of poor outcomes was increased with greater use of antiseizure medication.Conclusions and RelevanceThis systematic review and meta-analysis found that women with epilepsy have worse perinatal outcomes compared with women without epilepsy. Women with epilepsy should receive pregnancy counseling from an epilepsy specialist who can also optimize their antiseizure medication regimen before and during pregnancy.

show abstract

Section: Resultsmentioning

confidence: 99%

Comparison of Perinatal Outcomes for Women With and Without Epilepsy

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Major malformations attributed to the use of carbamazepine during pregnancy are neural tube defects [40,49] , cardiac malformations, and cleft lip/palate [49][50][51] . Other adverse pregnancy outcomes associated with the in utero exposure to carbamazepine are emergency cesarean section, developmental delay, microcephaly, growth retardation, cerebral hemorrhage, and abnormal ophthalmic findings [31,40,52] .…”

Section: Discussionmentioning

confidence: 99%

Fetal Malformations Associated with the Use of Methylphenobarbital and Carbamazepine during Pregnancy

Akšamija¹,

Habek²,

Stanojević³

et al. 2009

Fetal Diagn Ther

View full text Add to dashboard Cite

The use of antiepileptic drugs (AEDs) during pregnancy has been associated with an increased risk of major and minor fetal malformations. This paper describes 2 infants with malformations born to epileptic mothers who used AEDs throughout pregnancy. In the first case, the AED used for seizure control was methylphenobarbital, while in the second case the patient had been prescribed carbamazepine. We noted major and minor congenital malformations in both infants exposed in utero to these anticonvulsant drugs. Pregnant women still experience poor obstetrical care because they report to tertiary centers at the end of their pregnancy or when in labor, making it difficult to provide proper medical care for both the infant and the mother.

show abstract

“…Epilepsy has been estimated to affect 0.3-1% of pregnant women and its treatment with AEDs should be aimed at carefully balancing the risk of seizures for both the mother and the baby [152] with the risk of teratogenic and other adverse effects in the newborn. [153][154][155][156][157][158] In a recent study, performed on data from the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP) database, it was estimated that from 2001 to 2007 the use of AEDs during pregnancy increased, mainly owing to a 5-fold increase in the use of newer AEDs. Older AEDs (i.e.…”

Section: Antiepileptic Drugs (Aeds)mentioning

confidence: 99%

“…[167] A case-control study described 4 cases of NAS among 37 newborns exposed to VPA monotherapy or in combination with primidone, carbamazepine or lamotrigine, as compared with no cases in control groups (untreated epileptic women or healthy women). [153] Symptoms of AED-related NAS are similar to those of opioid withdrawal. They usually occur during the first few hours after birth, up to one week after delivery, and may persist for weeks and months.…”

Section: Antiepileptic Drugs (Aeds)mentioning

confidence: 99%

Neonatal Adaptation Issues After Maternal Exposure to Prescription Drugs: Withdrawal Syndromes and Residual Pharmacological Effects

et al. 2016

View full text Add to dashboard Cite

Exposure to drugs during pregnancy has the potential to harm offspring. Teratogenic effects are the most feared adverse outcomes in newborns; however, a wide spectrum of less known, usually reversible and often acute, neonatal adverse events can also occur due to drug intake by mothers during pregnancy, particularly in close proximity to delivery. This narrative review is aimed at the description of drugs and drug classes for which licit maternal use in the predelivery period has been associated with neonatal non-teratogenic disorders. For each drug class, epidemiology, clinical features, biological mechanism and management of these adverse reactions have been discussed in detail. Although these adverse reactions have been described mainly for substances used illicitly for recreational purposes, several prescription drugs have also been involved; these include mainly psychotropic medications such as opioids, antidepressants, antiepileptics and antipsychotics. These effects can be partly explained by withdrawal syndromes (defined also as 'neonatal abstinence syndrome') caused by the delivery-related discontinuation of the drug disposition from the mother to the fetus, with symptoms that may include feeding disorders, tremors, irritability, hypotonia/hypertonia, vomiting and persistent crying, occurring a few hours to 1 month after delivery. Otherwise, neonatal neurological and behavioral effects can also be caused by a residual pharmacological effect due to an accumulation of the drug in the blood and tissues of the newborn, with various symptoms related to the toxic effects of the specific drug class, usually developing a few hours after birth. With few exceptions, validated protocols for the assessment and management of withdrawal or residual pharmacological effects of these drugs in neonates are often lacking or incomplete. Spontaneous reporting of these adverse reactions seems limited, although it might represent a useful tool for improving our knowledge about drug-induced neonatal syndromes.

show abstract

The frequency of neonatal morbidity after exposure to antiepileptic drugs in utero

Abstract: Prenatal antiepileptic drug exposure in the setting of maternal epilepsy is associated with increased risk of neonatal morbidity. In our study a particularly significant connection was established between carbamazepine therapy during pregnancy and cerebral hemorrhage in the neonates.

Cited by 8 publications

References 41 publications

Comparison of Perinatal Outcomes for Women With and Without Epilepsy

Comparison of Perinatal Outcomes for Women With and Without Epilepsy

Fetal Malformations Associated with the Use of Methylphenobarbital and Carbamazepine during Pregnancy

Neonatal Adaptation Issues After Maternal Exposure to Prescription Drugs: Withdrawal Syndromes and Residual Pharmacological Effects

Contact Info

Product

Resources

About