Pregnancy with epilepsy: obstetric and neonatal outcome of a controlled study

Abstract

Purpose: To determine the influence of epilepsy and its treatment on pregnancy and its outcome.

Design: Controlled, observational study.

Setting: National Health Service maternity hospitals in Liverpool and Manchester regions.

Population: 277 women with epilepsy (WWE) and 315 control women.

Methods: WWE were recruited from antenatal clinics. Controls were matched for age and parity but not gestational age. Information was obtained by interview and from clinical records.

Main outcome measures: Obstetric complications, mode of delivery, condition of newborn.

Results: Distribution of epilepsy syndromes was similar to previous surveys. Most WWE (67%) received monotherapy with carbamazepine, sodium valproate or lamotrigine. Half WWE had no seizures during pregnancy but 34% had tonic clonic seizures. Seizure-related injuries were infrequent. Pregnancies with obstetric complications were increased in women with treated epilepsy (WWTE 45%, controls 33%; p=0.01). Most had normal vaginal delivery (WWTE 63%, controls 61%; p=0.65). Low birth weight was not increased (WWTE 6.2%, controls 5.2%; p=0.69). There were more major congenital malformations (MCM) (WWTE 6.6%, controls 2.1%; p=0.02) and fetal/infant deaths (WWTE 2.2%, controls 0.3%; p=0.09). Amongst monotherapies MCM prevalence was highest with valproate (11.3%; p=0.005). Lamotrigine (5.4%; p=0.23) and carbamazepine (3.0%; p=0.65) were closer to controls (2.1%). There was no association between MCM and dose of folic acid pre-conception.

Conclusion: MCM were more prevalent in the babies of WWTE particularly amongst those receiving sodium valproate.