Major congenital malformations in children of women with epilepsy

Tomson, Torbjörn; Hai, Xue; Battino, Dina

doi:10.1016/j.seizure.2015.02.019

Cited by 70 publications

(42 citation statements)

References 30 publications

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“…In general, cardiovascular defects, in particular ventricular septal defects, are the most common congenital malformations for children born to both healthy women and women with epilepsy. 33,54,98,99 Neural tube defects, cleft palate and cleft lip, and hypospadias have also been associated with exposure to anticonvulsant mood stabilisers although they are rare events and the estimates vary considerably. 18,98 Our estimates of absolute risks and risk differences for major congenital malformations match closely with previous reports from UK epilepsy registries.…”

Section: Anticonvulsant Mood Stabilisersmentioning

confidence: 99%

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

133

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BackgroundAlthough many women treated with psychotropic medication become pregnant, no psychotropic medication has been licensed for use in pregnancy. This leaves women and their health-care professionals in a treatment dilemma, as they need to balance the health of the woman with that of the unborn child. The aim of this project was to investigate the risks and benefits of psychotropic medication in women treated for psychosis who become pregnant.Objective(s)(1) To provide a descriptive account of psychotropic medication prescribed before pregnancy, during pregnancy and up to 15 months after delivery in UK primary care from 1995 to 2012; (2) to identify risk factors predictive of discontinuation and restarting of lithium (multiple manufacturers), anticonvulsant mood stabilisers and antipsychotic medication; (3) to examine the extent to which pregnancy is a determinant for discontinuation of psychotropic medication; (4) to examine prevalence of records suggestive of adverse mental health, deterioration or relapse 18 months before and during pregnancy, and up to 15 months after delivery; and (5) to estimate absolute and relative risks of adverse maternal and child outcomes of psychotropic treatment in pregnancy.DesignRetrospective cohort studies.SettingPrimary care.ParticipantsWomen treated for psychosis who became pregnant, and their children.InterventionsTreatment with antipsychotics, lithium or anticonvulsant mood stabilisers.Main outcome measuresDiscontinuation and restarting of treatment; worsening of mental health; acute pre-eclampsia/gestational hypertension; gestational diabetes; caesarean section; perinatal death; major congenital malformations; poor birth outcome (low birthweight, preterm birth, small for gestational age, low Apgar score); transient poor birth outcomes (tremor, agitation, breathing and muscle tone problems); and neurodevelopmental and behavioural disorders.Data sourcesClinical Practice Research Datalink database and The Health Improvement Network primary care database.ResultsPrescribing of psychotropic medication was relatively constant before pregnancy, decreased sharply in early pregnancy and peaked after delivery. Antipsychotic and anticonvulsant treatment increased over the study period. The recording of markers of worsening mental health peaked after delivery. Pregnancy was a strong determinant for discontinuation of psychotropic medication. However, between 40% and 76% of women who discontinued psychotropic medication before or in early pregnancy restarted treatment by 15 months after delivery. The risk of major congenital malformations, and neurodevelopmental and behavioural outcomes in valproate (multiple manufacturers) users was twice that in users of other anticonvulsants. The risks of adverse maternal and child outcomes in women who continued antipsychotic use in pregnancy were not greater than in those who discontinued treatment before pregnancy.LimitationsA few women would have received parts of their care outside primary care, which may not be captured in this analysis. Likewise, the analyses were based on prescribing data, which may differ from usage.ConclusionsPsychotropic medication is prescribed before, during and after pregnancy. Many women discontinue treatment before or during early pregnancy and then restart again in late pregnancy or after delivery. Our results support previous associations between valproate and adverse child outcomes but we found no evidence of such an association for antipsychotics.Future workFuture research should focus on (1) curtailing the use of sodium valproate; (2) estimating the benefits of psychotropic drug use in pregnancy; and (3) investigating the risks associated with lifestyle choices that are more prevalent among women using psychotropic drugs.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

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Section: Anticonvulsant Mood Stabilisersmentioning

confidence: 99%

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

133

View full text Add to dashboard Cite

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“…Studies have focused on consequences of epilepsy and maternal AED use during pregnancy for fetal malformations and child development (21)(22)(23)(24). In contrast, potential effects of epilepsy and specific AEDs on pregnancy have been much less studied.…”

Section: Key Messagementioning

confidence: 99%

The effect of parity on risk of complications in pregnant women with epilepsy: a population‐based cohort study

Danielsson

Borthen

Gilhus

et al. 2018

Acta Obstet Gynecol Scand

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“…Also, there is the increased risk for development of reproductive-endocrine disorders and infertility in women with epilepsy on long-term AED therapy [7] . Fetal exposure to AEDs increases the risk of congenital malformations [8] and neurodevelopmental impairment [9,10] in offspring of women with epilepsy.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and predictive biomarkers of drug resistant epilepsy -- study in Georgia

Alkhidze¹,

Lomidze²,

Kasradze³

et al. 2017

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Aim:The authors conducted a case-control study to estimate predictive factors for timely identification of patients at higher risk for developing drug resistant epilepsy. Methods: The retrospective case-control study was conducted among people diagnosed as having drug resistant epilepsy (cases) and their controls, identified as having drug-responsive seizures. All participants were admitted to the tertiary Epilepsy Center at the Institute of Neurology and Neuropsychology (Tbilisi, Georgia) during 2011. The data on demographic features and disease characteristics were analyzed. Multiple logistic regression analysis was used to identify independent risk factors for development of intractable epilepsy. Results: A total 334 patients were identified; 84 (34%) met the criteria for drug resistant epilepsy. One hundred and sixty-four age-and gender-matched controls with drug-responsive epilepsy were identified. Relative to the control group, the drug resistant seizure group had increased frequency of perinatal pathology (24% vs. 12%), febrile seizures (22% vs. 12%), seizure frequency at disease manifestation (62% vs. 19%), occurrence of convulsive seizures (84% vs. 70%), electroencephalo-graph (EEG) epileptiform discharges (94% vs. 77%), polytherapy (90% vs. 12%), multilobar lesions (30% vs. 16%), hippocampal sclerosis (18% vs. 5%), and malformations of cortical development (8% vs. 2%). Multivariate analysis indicated four factors with independent predictive value for development of intractable epilepsy: frequency of seizure, polymorphism of seizure, polytherapy, and epileptiform EEG abnormalities. Original ArticleThis is an open access article distributed under the terms of the Creative Commons AttributionNonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. 192The presence of all four factors in combination resulted in a 98% of probability of developing drug resistant epilepsy. Conclusion: Several factors appear to have prognostic value in identifying the risk for drug resistant epilepsy. These factors may prove useful in non-specialized health care settings for timely identification of individuals with elevated risk for drug resistant epilepsy. However, retrospective design and possible recall bias must be considered when interpreting or extrapolating these results.

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Major congenital malformations in children of women with epilepsy

Cited by 70 publications

References 30 publications

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

The effect of parity on risk of complications in pregnant women with epilepsy: a population‐based cohort study

Characteristics and predictive biomarkers of drug resistant epilepsy -- study in Georgia

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