Statistics on Deliveries of Mothers with Epilepsy at Yokohama City University Hospital

Abstract

Summary:Purpose: To survey and summarize the treatment of pregnant women with epilepsy and to obtain data for the improvement of daily treatment regimens.Methods: We reviewed medical records of 36 deliveries of 25 mothers with epilepsy at Yokohama City University Hospital from September 1991 to December 2000 and statistically compared the differences in drug-taking profiles, complications during pregnancy, types of delivery, and complications at delivery between the epilepsy group and a control group (656 total deliveries after 22 weeks except for epilepsy cases in 1991 and 1992 at Yokohama City University Hospital).Results: Of the 25 mothers with epilepsy, three with idiopathic generalized epilepsy, 12 were symptomatic for partial epilepsy. Their mean age at delivery was 29.0 years. The mean age at onset of epilepsy was 13.9 years. Of the 36 pregnancies, 30 (83.3%) cases continued antiepileptic drug (AED) taking throughout the pregnancies; 23 (63.9%) cases received monotherapy. Phenobarbital was the most frequently used drug in monotherapies. Seven (19.4%) cases received polytherapy. Seven (19.4%) patients experienced epileptic seizures during pregnancy. One case showed a low serum AED level. No statistically significant difference was found in complications during pregnancy, types of delivery, or complications at delivery, excluding abnormal rotation in the birth canal. Congenital malformation (cleft lip with palate) was observed in one (2.9%) case. The mother was 39 years old at delivery and had myoma uteri. Onset of epilepsy was at 14 years. She had been taking three kinds of AEDs: 1,400 mg/day of sodium valproate (VPA), 1.5 mg/day of clonazepam (CZP), and 200 mg/day of zonisamide (ZNS). Serum concentrations at pregnancy week 10 were 85.3 µg/ml VPA, 18.1 µg/L CZP, and 10.5 µg/ml ZNS. She also had been taking folic acid, 5 mg/day, but the serum concentration was not measured.Conclusions: The method of treatment and the management of pregnancy were left to the discretion of each doctor. However, in most cases, monotherapy was selected; and the frequency of complications was not significantly different from that of the control group, excluding the frequency of abnormal rotation in the birth canal. However, we could have been more proactive in calculating the risks of pregnancy for women with epilepsy and adjusted treatment in anticipation of a planned pregnancy, before the patient actually became pregnant. Additionally, a closer working relationship between the obstetrician and the physician who treats the epilepsy would seem to be a further requirement for the patient's well-being, as well as her child's, during pregnancy.

Obstetric outcome in women with epilepsy: a hospital-based, retrospective study

“…The induction rate in women with epilepsy was increased, mainly in those using AEDs. This is in accordance with some previous studies, 6,15,23 but contrary to the findings in others, where no difference was seen 18,43 . According to guidelines, 1,44 epilepsy is not an indication for induction in uncomplicated pregnancies.…”

“…Some authors have demonstrated increased risks of gestational hypertension, 15,16 pre-eclampsia 4,16,17 and bleeding in pregnancy 4 compared with the general population, whereas others could not demonstrate such differences. 5,6,18 It is unclear whether or not any increased risk of complications occurs because of epilepsy per se, the use of AEDs 19 or other factors affecting women with epilepsy. If the effect of AEDs is important, the change to newer AEDs may lead to changes in these risks.…”

Teratogenicity of Antiepileptic Drugs

“…[23][24][25][26] Similarly, in our study, seizure frequency remained the same in 70.1% of the cases.…”

Maternal epilepsy and adverse pregnancy outcomes

“…As a doctor or patient, one should start with a preconception dialogue with a focus on the importance of a planned pregnancy with optimizing AED use, folate supplementation, the teratogenicity of AEDs versus the risks of seizures, and the risk of obstetric complications [53]. Two studies on women treated with the old-generation AEDs have reported increased risks of bleeding in pregnancy, preeclampsia and preterm birth [54,55], but this has not been replicated in other studies [3][4][5][56][57][58]. It has been discussed whether differences in AED use or the epilepsy type cohort are responsible for these differences [59].…”

“…According to guidelines in England and Norway, induction of labor should be evaluated on an individual basis [69,101]. Deliveries with forceps and vacuum are not increased in women with epilepsy [3][4][5]70]. This may be due to the high rates of CD, but may also reflect few complications during labor.…”