Epilepsy has a prevalence of 1.65% in adults, and every 1 in 200 pregnancies encounters its complications. We aimed to present the existing condition of and our experience with epileptic pregnant women for whom the prepregnancy counseling is inadequate in Turkey.
We evaluated 149 epileptic pregnant women between March 2009 and January 2015. Demographic features of the patients, along with type and duration of epileptic seizure, time of diagnosis, date of last seizure prior to pregnancy, number and duration of seizures during pregnancy, type of AEDs, result and week of termination of pregnancy, and birth weight were registered, and also, we evaluated perinatal complications and fetal malformations.
Mean age of the patients was 27.12 ± 5.4 years, and mean duration from the diagnosis of epilepsy to pregnancy was 9.68 ± 5.91 years. Twenty-seven (18.12%) and 101 (67.78%) patients had polytherapy and monotherapy, respectively. We observed epileptic seizures in 103 (69.12%) patients during pregnancy, and seizures mostly occurred in the first and third trimesters. Forty-one (39.80%) patients had seizures in all three trimesters. Forty-two (28.18%) patients among all patients who had seizures during pregnancy had 5 or more seizures. Major malformations, namely, cleft lip and palate, ventriculoseptal defect, and spina bifida were observed in the patients. Mean birth week was 38.43 ± 1.68 weeks, and mean birth weight was 2965.31 ± 453.94 grams. Twenty-two patients had normal spontaneous vaginal delivery whereas 118 patients had cesarean section.
Pregnant women with epilepsy have their own risks. These women should be followed by experienced obstetricians and neurologists during their pregnancies. Appropriate management and follow-up lead to good results almost the same as general population.
Brodie MJ , Dichter MA: Antiepileptic drugs. N Engl J Med 334, 168–175 (1996)
Sveberg L , Svalheim S, Taubøll E: The impact of seizures on pregnancy and delivery. Seizure pii: S1059–1311 (2015)
Kjaer D , Horvath-Puhó E, Christensen J, Vestergaard M, Czeizel AE, Sørensen HT, Olsen J: Antiepileptic drug use, folic acid supplementation, and congenital abnormalities: a population-based case-control study. BJOG 115, 98–103 (2008)
Lindhout D , Omtzigt JG: Teratogenic effects of antiepileptic drugs: implications for the management of epilepsy in women of childbearing age. Epilepsia 35, 19–28 (1994)
Fried S , Kozer E, Nulman I, Einarson TR, Koren G: Malformation rates in children of women with untreated epilepsy: a meta-analysis. Drug Saf 27, 197–202 (2004)
Adab N , Kini U, Vinten J, Ayres J, Baker G, Clayton-Smith J, Coyle H, Fryer A, Gorry J, Gregg J, Mawer G, Nicolaides P, Pickering L, Tunnicliffe L, Chadwick DW: The longer term outcome of children born to mothers with epilepsy. J Neurol Neurosurg Psychiatry 75, 1575–1583 (2004)
Meador KJ , Baker GA, Finnell RH, Kalayjian LA, Liporace JD, Loring DW, Mawer G, Pennell PB, Smith JC, Wolff MC, NEAD Study Group: Inutero antiepileptic drug exposure: Fetal death and malformations. Neurology 67, 407–412 (2006).
Viinikainen K , Heinonen S, Eriksson K, Kälviäinen R: Community- based, prospective, controlled study of obstetric and neonatal outcome of 179 pregnancies in women with epilepsy. Epilepsia 47, 186–192 (2006)
Vajda FJ , Hitchcock A, Graham J, O’Brien T, Lander C, Eadie M: Seizure control in antiepileptic drug-treated pregnancy. Epilepsia 49, 172–176 (2008).
Aminoff MJ , Douglas VC (2014): Neurologic Disorders. In: Maternal-Fetal Medicine, eds. Creasy RK, Resnik R et al., Saunders, Philadelphia, pp. 1100–1102.
Thomas SV , Ajaykumar B, Sindhu K, Francis E, Namboodiri N, Sivasankaran S, Tharakan JA, Sarma PS: Cardiac malformations are increased in infants of mothers with epilepsy. Pediatr Cardiol 29, 604–608 (2008).
Buhimschi CS , Weiner CP: Medication in pregnancy and lactation: part 1. Teratology Obstet Gynecol 113, 166–188 (2009)
Eadie MJ : Antiepileptic drugs as human teratogens. Expert Opin Drug Saf 7, 195–209 (2008)
Meador KJ , Baker GA, Browning N, Clayton-Smith J, Combs-Cantrell DT, Cohen M, Kalayjian LA, Kanner A, Liporace JD, Pennell PB, Privitera M, Loring DW, NEAD Study Group: Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs. N Engl J Med 360, 1597–1605 (2009)
Harden CL , Hopp J, Ting TY, Pennell PB, French JA, Hauser WA, Wiebe S, Gronseth GS, Thurman D, Meador KJ, Koppel BS, Kaplan PW, Robinson JN, Gidal B, Hovinga CA, Wilner AN, Vazquez B, Holmes L, Krumholz A, Finnell R, Le Guen C, American Academy of Neurology, American Epilepsy Society: Practice parameter update: management issues for women with epilepsy –focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology 73, 126–132 (2009)
Pilo C , Wide K, Winbladh B: Pregnancy, delivery, and neonatal complications after treatment with antiepileptic drugs. Acta Obstet Gynecol 85, 643–646 (2006)
Turner K , Piazzini A, Franza A, Marconi AM, Canger R, Canevini MP: Epilepsy and postpartum depression. Epilepsia 50, 24–27 (2009)
Adab N : Therapeutic monitoring of antiepileptic drugs during pregnancy and in the postpartum period: Is it useful? CNS Drugs 20, 791–800 (2006)
Hiilesmaa VK : Pregnancy and birth in women with epilepsy. Neurology 42, 8–11 (1992)
European Registry of Antiepileptic Drugs and Pregnancy (EURAP) Study Group: Seizure control and treatment in pregnancy. Observations from the EURAP Epilepsy Pregnancy Registry. Neurology 66, 354–360 (2006)
Ozdemir O , Sari ME, Ertugrul FA, Kurt A, Selimova V, Atalay CR: The effects of a history of seizures during pregnancy on umbilical arterial blood gas values in pregnant women with epilepsy. J Turk Ger Gynecol Assoc 15, 135–139 (2014)