Obstetric and neonatal outcomes: Antiseizure medication profile and seizure types in pregnant women in a vulnerability state, Brazil

Abstract

Objectives: To describe obstetric and neonatal outcomes, antiseizure medication (ASM), and types of seizures in pregnant women with epilepsy (PWWE). Methods: In this retrospective cohort study using data collected from the medical records obtained from high-risk maternity hospitals in Alagoas. PWWE and pregnant women without epilepsy (control group) between 2008 and 2020, aged <40 years with controlled or refractory seizures. Results: The obstetric and neonatal outcomes observed in PWWE were pregnancy-related hypertension (PrH) (odds ratio [OR]=6.29; 95% confidence interval (CI)=3.50–11.30), vaginal bleeding (OR=2.54; 95% CI=1.15–5.59), preeclampsia (OR=8.04; 95% CI=2.22–29.10), oligohydramnyos OR=4,57; 95% CI=2.24–9,31), polyhydramnios (OR=7.55; 95% CI=1.55–36.65), miscarriage (OR=1.75;95% CI=1.16–2.63), stillbirth (OR=11,16; 95% CI=2.22–29.10), greater likelihood of PrH in those with generalized tonic-clonic seizures (GTCS) (OR=8.05; 95% CI=3.47–18.64), maternal ICU admission in those with GTCS and status epilepticus (OR=11.73; 95% CI=2.44–56.37 vs. OR=37.50; 95% CI=8.32–168.84, respectively) and phenytoin and lamotrigine use (OR=17.75; 95% CI=1.95–160.77 vs. OR=7.10; 95% CI=1.03–48.64). PWWE with GTCS had a higher chance for stillbirth (OR=3.41; 95% CI=1.03–11.28). and status epilepticus to deliver prematurely (OR=2.22; 95% CI=1.05–4.69). PWWE with status epilepticus using lamotrigine (OR=21,91; 95% CI=2.07–231.60). Phenobarbital(PB) with diazepam was commonly used by GTCS and status epilepticus (OR=12.04; 95% CI=1.43–101.47). Only 14% didn’t use ASM, 50.2% used monotherapy, and 35.8% polytherapy. PB was used (60.9%), and carbamazepine (25.2%). Conclusion: This study described association to adverse obstetric and neonatal outcomes and severe seizure types in PWWE.