Age‐specific birth rates in women with epilepsy: a population‐based study

Farmen, Anette Huuse; Grundt, Jacob Holter; Tomson, Torbjörn; Nakken, Karl Otto; Nakling, Jakob; Mowinchel, Petter; Øie, Merete Glenne; Lossius, Morten I.

doi:10.1002/brb3.492

Cited by 19 publications

(16 citation statements)

References 20 publications

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“…There has been controversy as to whether women with epilepsy (WWE) are at increased risk for infertility and impaired fecundity and whether antiepileptic drug (AED) use and AED category are factors. The majority of retrospective studies have found that WWE have lower birth rates and fewer children than women in the general population . However, a retrospective cohort study of the Icelandic population found no significant difference in incident fertility rates between WWE and women in the general population, and a prospective controlled study of 89 WWE seeking pregnancy and 108 controls in the USA found no difference in fertility rates between the two groups over the course of a 1‐year follow‐up .…”

Section: Introductionmentioning

confidence: 98%

Infertility, impaired fecundity, and live birth/pregnancy ratio in women with epilepsy in the USA: Findings of the Epilepsy Birth Control Registry

2019

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Objective To determine the current risks of infertility and impaired fecundity as well as the live birth/pregnancy ratio among women with epilepsy (WWE) in the USA and whether antiepileptic drug (AED) use is a factor. Methods These retrospective survey data come from the 2010‐2014 Epilepsy Birth Control Registry (EBCR) Web‐based survey of 1000 WWE in the USA, aged 18‐47 years, who provided demographic, epilepsy, AED, reproductive, and contraceptive data. We report risks of infertility and impaired fecundity, live birth/pregnancy ratio, and whether outcomes differ by AED use or category versus No AED. Results A total of 978 of the 1000 USA WWE reported reproductive data; 373 WWE had 724 pregnancies and 445 births. An additional 38 WWE (9.2%, 95% confidence interval [CI] = 6.7‐12.4%) tried to conceive but were infertile. A total of 72.5% had a live birth outcome for their first pregnancy, 89.0% had at least one live birth for their first two pregnancies, and 61.6% had two live births for their first two pregnancies. Eighty‐four of 406 WWE (20.7%, 95% CI = 17.0‐2.9%) had impaired fecundity. The risk of impaired fecundity trended higher on AED polytherapy than on No AED (risk ratio [RR] = 1.79, 95% CI = 0.94‐3.11, P = .08). The ratio of live birth/unaborted pregnancy (445/594, 74.9%) was similar among WWE on No AED (71.3%), AED monotherapy (71.8%), and polytherapy (69.7%). None of the AED categories differed significantly from No AED. Note that glucuronidated AED (lamotrigine), which had the highest ratio of live birth/pregnancy (89.1%), compared favorably to enzyme‐inhibiting AED (valproate), which had the lowest (63.3%; RR = 1.41, 95% CI = 1.05‐1.88, P = .02). Significance The EBCR finds 9.2% infertility risk and 20.7% impaired fecundity risk among WWE in the USA. Impaired fecundity trended higher on AED polytherapy than on No AED. Live birth/pregnancy ratio was higher with the use of lamotrigine than valproate. These findings may provide WWE a more objective basis for pregnancy planning.

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Section: Introductionmentioning

confidence: 98%

Infertility, impaired fecundity, and live birth/pregnancy ratio in women with epilepsy in the USA: Findings of the Epilepsy Birth Control Registry

2019

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“…Patients with COE have lower fertility when compared to unaffected controls . Adult onset and active epilepsy have also been associated with lowered fertility in large population‐based studies . Both physical and social factors likely contribute to lowered fertility.…”

Section: Introductionmentioning

confidence: 99%

Fertility and marital status in adults with childhood onset epilepsy: A population‐based cohort study

et al. 2019

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Objective Our objective was to explore the association of childhood onset epilepsy (COE) and clinical factors on marital status and fertility in adulthood. Methods We identified a population‐based cohort of 307 individuals with COE treated in the Tampere University Hospital district with an inception date of December 31, 1992. A matched reference cohort of 1244 individuals without COE was established as a random sample of the population in the study area through the Population Register Center (PRC). The PRC also provided data on marriages and offspring up to 2018. Fertility and marriage analysis was done by calculating the time until first child and marriage. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated with Cox regression for follow‐up spanning up to January 2018. Results Patients with COE had lower fertility rates (32.2% vs 57.3% any offspring, HR = 0.47, 95% CI = 0.38‐0.58) and fewer marriages (28.3% vs 49.7% ever married, HR = 0.49, 95% CI = 0.39‐0.61) than the referents without COE during 25‐year follow‐up. The largest impact was in patients with COE who had any disability (10.1% any offspring, HR = 0.20, 95% CI = 0.10‐0.41; 6.5% ever married, HR = 0.11, 95% CI = 0.06‐0.21), symptomatic etiology of epilepsy (13.1%, HR = 0.18, 95% CI = 0.11‐0.31; 12.1%, HR = 0.21, 95% CI = 0.12‐0.36), onset of epilepsy before 2 years of age (HR = 0.20, 95% CI = 0.12‐0.31; HR = 0.29, 95% CI = 0.18‐0.46), and high seizure frequency after start of treatment (HR = 0.13, 95% CI = 0.06‐0.28; HR = 0.20, 95% CI = 0.10‐0.41). Patients with COE without any disabilities had only slightly lowered fertility (HR = 0.76, 95% CI = 0.61‐0.95) and a nonsignificant reduction in marriages (HR = 0.80, 95% CI = 0.64‐1.02). Significance COE was associated with a lower chance of finding a partner at adulthood and having fewer children. The extent of such effect varied between patient subgroups.

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“…the epilepsy group and healthy group (women without registered chronic diseases). The validation procedure of epilepsy is described elsewhere . The frequency of epilepsy was 0.60%.…”

Section: Methodsmentioning

confidence: 99%

Increased rate of acute caesarean sections in women with epilepsy: results from the Oppland Perinatal Database in Norway

Farmen

Grundt

Nakling

et al. 2018

Euro J of Neurology

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Background and purpose Studies in women with epilepsy ( WWE ) regarding pregnancy and labour complications have disclosed contradictory results. Our purpose was to investigate whether WWE have a higher risk of acute caesarean section ( CS ) or pregnancy complications than women without epilepsy or women with other chronic diseases and, if we found a higher risk, to explore potential explanations. Methods The study used prospectively registered obstetric data from the Oppland Perinatal Database in the period 2001–2011, containing information on 18 244 births, including 110 singleton pregnancies in mothers with validated epilepsy. Data regarding epilepsy were collected retrospectively from medical records. Results Epilepsy was a significant risk factor for acute CS , breech presentation and low birth weight in offspring [odds ratio ( OR), 1.93, 95% confidence interval (CI), 1.2–3.1; OR, 2.29, 95% CI, 1.2–4.6 and OR, 2.10, 95% CI, 1.0–4.2, respectively]. In multivariate logistic regression analysis, antiepileptic drug exposure was an independent risk factor for acute CS ( OR, 2.00; 95% CI, 1.06–3.77) and polytherapy was a significant risk factor for breech presentation ( OR, 5.37; 95% CI, 1.13–25.57). Seizure frequency during pregnancy had no influence on the complication rate. Conclusions We found that WWE using antiepileptic drugs during pregnancy had increased rates of acute CS , breech presentation and low birth weight, and that seizure frequency during pregnancy did not influence the complication rate.

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Age‐specific birth rates in women with epilepsy: a population‐based study

Cited by 19 publications

References 20 publications

Infertility, impaired fecundity, and live birth/pregnancy ratio in women with epilepsy in the USA: Findings of the Epilepsy Birth Control Registry

Infertility, impaired fecundity, and live birth/pregnancy ratio in women with epilepsy in the USA: Findings of the Epilepsy Birth Control Registry

Fertility and marital status in adults with childhood onset epilepsy: A population‐based cohort study

Increased rate of acute caesarean sections in women with epilepsy: results from the Oppland Perinatal Database in Norway

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