NEUROLOGICAL AND FETAL OUTCOMES OF PREGNANCIES OF MOTHERS WITH EPILEPSY
Abstract number :
3.120
Submission category :
Year :
2002
Submission ID :
1496
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
William T. Cahill, Oormila P. Kovilam, Dorothy Pastor, Jane C. Khoury, Jerzy P. Szaflarski, David M. Ficker, Michael D. Privitera. Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH; Department of Obstetrics and Gynecology, U
RATIONALE: After completing this activity, the reader will be able to describe the outcome of epilepsy and its treatment during pregnancy.
A higher incidence of adverse fetal outcomes has been reported in pregnancies of mothers with epilepsy (ME). Prior studies have minimized the impact of pregnancy on epilepsy control. There have been no recent large studies in the United States. We sought to review the neurological and fetal outcomes of pregnancies of ME treated at a university medical center.
METHODS: At the University of Cincinnati Medical Center, 215 ME were evaluated during the period from 1991 to 2001. Of these, 25 were not on any antiepileptic drug (AED), 129 were on one AED, and 61 were on more than one AED. Pregnancy outcomes were reviewed including birth weights, Apgar scores, and proportion of infants who were small for gestational age (SGA). Changes in seizure control and AED dosage were examined. Analysis of variance was used for continuous variables while categorical variables were analyzed by chi-square.
RESULTS: No significant difference was seen across the three groups of infants of ME for gestational age, birth weight, Apgar scores, or parity. The proportion who were primigravida was greater for ME on no AED. This may be related to their lower mean age. The use of tobacco (p=.206) and alcohol (p=.555) in pregnancy were not significantly different. First trimester seizures occurred significantly more often in the treated groups. Hospitalization for seizures in pregnancy was greater for ME on polytherapy compared to no AED. AED dose was increased more often in those on polytherapy than in those on monotherapy. In about half of ME on AED, the dose was increased due to seizures. The occurrence of 5 minute Apgar score [lt]7 and SGA were not significantly different across these groups.
CONCLUSIONS: Use of an AED in pregnancy does not significantly affect gestational age, birth weight, or neonatal compromise as measured by Apgar scores. ME on AED are more likely to have seizures in the first trimester. ME on polytherapy are more likely to require adjustment of their AED doses and hospitalization for seizures. ME should be monitored closely during pregnancy to ensure optimal neurological and fetal outcome.[table1]