Maternal complications in pregnancy and childbirth for women with epilepsy: Time trends in a nationwide cohort

English version

Autoři: Kim Christian Danielsson ^aff001; Nils Erik Gilhus ^aff002; Ingrid Borthen ^aff002; Rolv Terje Lie ^aff004; Nils-Halvdan Morken ^aff001
Působiště autorů: Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway ^aff001; Department of Clinical Medicine, University of Bergen, Bergen, Norway ^aff002; Department of Neurology, Haukeland University Hospital, Bergen, Norway ^aff003; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ^aff004; Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway ^aff005; Department of Clinical Science, University of Bergen, Bergen, Norway ^aff006
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0225334

Souhrn

Objective

Obstetric trends show changes in complication rates and maternal characteristics such as caesarean section, induced labour, and maternal age. To what degree such general time trends and changing patterns of antiepileptic drug use influence pregnancies of women with epilepsy (WWE) is unknown. Our aim was to describe changes in maternal characteristics and obstetric complications in WWE over time, and to assess changes in complication risks in WWE relative to women without epilepsy.

Methods

This was a nationwide cohort study of all first births in the Medical Birth Registry of Norway, 1999–2016. We estimated maternal characteristics, complication rates, and risks for WWE compared to women without epilepsy. Main maternal outcome measures were hypertensive disorders, bleeding in pregnancy, induction of labour, caesarean section, postpartum hemorrhage, preterm birth, small for gestational age, and epidural analgesia. Time trends were analyzed by logistic regression and comparisons made with interaction analyses.

Results

426 347 first births were analyzed, and 3077 (0.7%) women had epilepsy. In WWE there was an increase in proportions of induced labour (p<0.005) and use of epidural analgesia (p<0.005), and a reduction in mild preeclampsia (p = 0.006). However, the risk of these outcomes did not change over time. Only the risk of severe preeclampsia increased significantly over time relative to women without epilepsy (p = 0.006). In WWE, folic acid supplementation increased significantly over time (p<0.005), and there was a decrease in smoking during pregnancy (p<0.005), but these changes were less pronounced than for women without epilepsy (p<0.005).

Conclusions

During 1999–2016 there were important changes in maternal characteristics and complication rates among WWE. However, outcome risks for WWE relative to women without epilepsy did not change despite changes in antiepileptic drug use patterns. The relative risk of severe preeclampsia increased in women with epilepsy.

Klíčová slova:

Birth – Labor and delivery – Pregnancy – Preterm birth – Preeclampsia – Hypertensive disorders in pregnancy – Epidural block – Epilepsy

Zdroje

1. Artama M, Gissler M, Malm H, Ritvanen A, Drug, Pregnancy G. Effects of maternal epilepsy and antiepileptic drug use during pregnancy on perinatal health in offspring: nationwide, retrospective cohort study in Finland. Drug safety. 2013;36(5):359–69. doi: 10.1007/s40264-013-0052-8 23615755

2. Borthen I, Eide MG, Veiby G, Daltveit AK, Gilhus NE. Complications during pregnancy in women with epilepsy: population-based cohort study. BJOG: an international journal of obstetrics and gynaecology. 2009;116(13):1736–42.

3. Kilic D, Pedersen H, Kjaersgaard MI, Parner ET, Vestergaard M, Sorensen MJ, et al. Birth outcomes after prenatal exposure to antiepileptic drugs—a population-based study. Epilepsia. 2014;55(11):1714–21. doi: 10.1111/epi.12758 25231599

4. Razaz N, Tomson T, Wikstrom AK, Cnattingius S. Association Between Pregnancy and Perinatal Outcomes Among Women With Epilepsy. JAMA neurology. 2017;74(8):983–91. doi: 10.1001/jamaneurol.2017.1310 28672292

5. Viale L, Allotey J, Cheong-See F, Arroyo-Manzano D, McCorry D, Bagary M, et al. Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet. 2015.

6. Harden CL, Hopp J, Ting TY, Pennell PB, French JA, Allen Hauser W, et al. Management issues for women with epilepsy-Focus on pregnancy (an evidence-based review): I. Obstetrical complications and change in seizure frequency: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Epilepsia. 2009;50(5):1229–36. doi: 10.1111/j.1528-1167.2009.02128.x 19496807

7. MacDonald SC, Bateman BT, McElrath TF, Hernandez-Diaz S. Mortality and Morbidity During Delivery Hospitalization Among Pregnant Women With Epilepsy in the United States. JAMA neurology. 2015;72(9):981–8. doi: 10.1001/jamaneurol.2015.1017 26147878

8. Borthen I, Eide MG, Daltveit AK, Gilhus NE. Delivery outcome of women with epilepsy: a population-based cohort study. BJOG: an international journal of obstetrics and gynaecology. 2010;117(12):1537–43.

9. Borthen I, Eide MG, Daltveit AK, Gilhus NE. Obstetric outcome in women with epilepsy: a hospital-based, retrospective study. BJOG: an international journal of obstetrics and gynaecology. 2011;118(8):956–65.

10. Weston J, Bromley R, Jackson CF, Adab N, Clayton-Smith J, Greenhalgh J, et al. Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child. The Cochrane database of systematic reviews. 2016;11:CD010224. doi: 10.1002/14651858.CD010224.pub2 27819746

11. Bromley R, Weston J, Adab N, Greenhalgh J, Sanniti A, McKay AJ, et al. Treatment for epilepsy in pregnancy: neurodevelopmental outcomes in the child. The Cochrane database of systematic reviews. 2014(10):CD010236. doi: 10.1002/14651858.CD010236.pub2 25354543

12. Vajda FJ, O'Brien T, Lander C, Graham J, Eadie M. The efficacy of the newer antiepileptic drugs in controlling seizures in pregnancy. Epilepsia. 2014;55(8):1229–34. doi: 10.1111/epi.12711 24995555

13. Kinney MO, Morrow J, Patterson CC, Campbell E, Russell A, Smithson HW, et al. Changing antiepilepsy drug-prescribing trends in women with epilepsy in the UK and Ireland and the impact on major congenital malformations. Journal of neurology, neurosurgery, and psychiatry. 2018.

14. Veiby G, Daltveit AK, Engelsen BA, Gilhus NE. Fetal growth restriction and birth defects with newer and older antiepileptic drugs during pregnancy. Journal of neurology. 2014;261(3):579–88. doi: 10.1007/s00415-013-7239-x 24449062

15. Gerard EE, Meador KJ. Managing Epilepsy in Women. Continuum. 2016;22(1 Epilepsy):204–26. doi: 10.1212/CON.0000000000000270 26844738

16. Borthen I, Gilhus NE. Pregnancy complications in patients with epilepsy. Current opinion in obstetrics & gynecology. 2012;24(2):78–83.

17. Battino D, Tomson T, Bonizzoni E, Craig J, Lindhout D, Sabers A, et al. Seizure control and treatment changes in pregnancy: observations from the EURAP epilepsy pregnancy registry. Epilepsia. 2013;54(9):1621–7. doi: 10.1111/epi.12302 23848605

18. Hernandez-Diaz S, Smith CR, Shen A, Mittendorf R, Hauser WA, Yerby M, et al. Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012;78(21):1692–9. doi: 10.1212/WNL.0b013e3182574f39 22551726

19. Thomas SV, Syam U, Devi JS. Predictors of seizures during pregnancy in women with epilepsy. Epilepsia. 2012;53(5):e85–8. doi: 10.1111/j.1528-1167.2012.03439.x 22429269

20. Collaborators GBDO, Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. The New England journal of medicine. 2017;377(1):13–27. doi: 10.1056/NEJMoa1614362 28604169

21. Grotvedt L, Kvalvik LG, Groholt EK, Akerkar R, Egeland GM. Development of Social and Demographic Differences in Maternal Smoking Between 1999 and 2014 in Norway. Nicotine & tobacco research: official journal of the Society for Research on Nicotine and Tobacco. 2017;19(5):539–46.

22. EURO-PERISTAT. Sharing national data and reporting: EURO-PERISTAT; 2012 [Sharing national data and reporting]. Available from: http://www.europeristat.com/reports/national-perinatal-health-reports.html.

23. Health NIoP. MBRN Statistics 2018 [Available from: http://statistikkbank.fhi.no/mfr/.

24. Recommendations for Induction of Labour. WHO Recommendations for Induction of Labour. WHO Guidelines Approved by the Guidelines Review Committee. Geneva2011.

25. Forening NG. Veileder i fødselshjelp 2014 [updated February 2014. Available from: http://legeforeningen.no/Fagmed/Norsk-gynekologisk-forening/Veiledere/Veileder-i-fodselshjelp-2014/.

26. World Health Organization Human Reproduction Programme A. WHO Statement on caesarean section rates. Reproductive health matters. 2015;23(45):149–50. doi: 10.1016/j.rhm.2015.07.007 26278843

27. RCOG. Epilepsy in Pregnancy (Green-top Guidlines No. 68) 2016 [Available from: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg68/.

28. NICE. Epilepsies: diagnosis and management [updated April 2018. Clinical Guideline 137]. Available from: https://www.nice.org.uk/guidance/cg137.

29. Aguglia U, Barboni G, Battino D, Cavazzuti GB, Citernesi A, Corosu R, et al. Italian consensus conference on epilepsy and pregnancy, labor and puerperium. Epilepsia. 2009;50 Suppl 1:7–23.

30. Harden C, Harden CL, Thomas SV, Tomson Tr. Epilepsy in women. 2013. Chichester, West Sussex: John Wiley & Sons.

31. Allotey J, Aroyo-Manzano D, Lopez P, Viale L, Zamora J, Thangaratinam S. Global variation in pregnancy complications in women with epilepsy: A meta-analysis. European journal of obstetrics, gynecology, and reproductive biology. 2017;215:12–9. doi: 10.1016/j.ejogrb.2017.05.016 28591672

32. Irgens LM. The Medical Birth Registry of Norway. Epidemiological research and surveillance throughout 30 years. Acta obstetricia et gynecologica Scandinavica. 2000;79(6):435–9. 10857866

33. Danielsson KC, Borthen I, Gilhus NE, Morken NH. The effect of parity on risk of complications in women with epilepsy: a population based cohort study. Acta obstetricia et gynecologica Scandinavica. 2018.

34. Danielsson KC, Borthen I, Morken NH, Gilhus NE. Hypertensive pregnancy complications in women with epilepsy and antiepileptic drugs: a population-based cohort study of first pregnancies in Norway. BMJ open. 2018;8(4):e020998. doi: 10.1136/bmjopen-2017-020998 29691249

35. Al Wattar BH, Tamilselvan K, Khan R, Kelso A, Sinha A, Pirie AM, et al. Development of a core outcome set for epilepsy in pregnancy (E-CORE): a national multi-stakeholder modified Delphi consensus study. BJOG: an international journal of obstetrics and gynaecology. 2017;124(4):661–7.

36. Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. Bmj. 2019;366:l2381. doi: 10.1136/bmj.l2381 31307997

37. Vogel JP, Betran AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. The Lancet Global health. 2015;3(5):e260–70. doi: 10.1016/S2214-109X(15)70094-X 25866355

38. Faught E, Helmers S, Thurman D, Kim H, Kalilani L. Patient characteristics and treatment patterns in patients with newly diagnosed epilepsy: A US database analysis. Epilepsy & behavior: E&B. 2018;85:37–44.

39. Tomson T, Battino D, Bonizzoni E, Craig J, Lindhout D, Sabers A, et al. Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lancet neurology. 2011;10(7):609–17. doi: 10.1016/S1474-4422(11)70107-7 21652013

40. Tomson T, Battino D, Bonizzoni E, Craig J, Lindhout D, Perucca E, et al. Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry. Lancet neurology. 2018;17(6):530–8. doi: 10.1016/S1474-4422(18)30107-8 29680205

41. Al-Zirqi I, Stray-Pedersen B, Forsen L, Kjersti Daltveit A, Vangen S, The NURg. Validation study of uterine rupture registration in the Medical Birth Registry of Norway. Acta obstetricia et gynecologica Scandinavica. 2013.

42. Baghestan E, Bordahl PE, Rasmussen SA, Sande AK, Lyslo I, Solvang I. A validation of the diagnosis of obstetric sphincter tears in two Norwegian databases, the Medical Birth Registry and the Patient Administration System. Acta obstetricia et gynecologica Scandinavica. 2007;86(2):205–9. doi: 10.1080/00016340601111364 17364284

43. Thomsen LC, Klungsoyr K, Roten LT, Tappert C, Araya E, Baerheim G, et al. Validity of the diagnosis of pre-eclampsia in the Medical Birth Registry of Norway. Acta obstetricia et gynecologica Scandinavica. 2013.

44. Skomsvoll J, Ostensen M, Baste V, Irgens L. Validity of a rheumatic disease diagnosis in the Medical Birth Registry of Norway. Acta obstetricia et gynecologica Scandinavica. 2002;81(9):831–4. doi: 10.1034/j.1600-0412.2002.810905.x 12225297

45. Hoff JM, Daltveit AK, Gilhus NE. Myasthenia gravis in pregnancy and birth: identifying risk factors, optimising care. European journal of neurology: the official journal of the European Federation of Neurological Societies. 2007;14(1):38–43.

46. Borthen I, Lossius P, Skjaerven R, Bergsjo P. Changes in frequency and indications for cesarean section in Norway 1967–1984. Acta obstetricia et gynecologica Scandinavica. 1989;68(7):589–93. doi: 10.3109/00016348909013275 2631525

47. Moth FN, Sebastian TR, Horn J, Rich-Edwards J, Romundstad PR, Asvold BO. Validity of a selection of pregnancy complications in the Medical Birth Registry of Norway. Acta obstetricia et gynecologica Scandinavica. 2016;95(5):519–27. doi: 10.1111/aogs.12868 26867143

48. Mostacci B, Bisulli F, Poluzzi E, Cocchi G, Piccinni C, Curti A, et al. Emilia-Romagna Study on Pregnancy and Exposure to Antiepileptic drugs (ESPEA): a population-based study on prescription patterns, pregnancy outcomes and fetal health. Journal of neurology, neurosurgery, and psychiatry. 2018.

49. Farmen AH, Grundt JH, Nakling JO, Mowinckel P, Nakken KO, Lossius MI. Increased rate of acute caesarean sections in women with epilepsy: results from the Oppland Perinatal Database in Norway. European journal of neurology: the official journal of the European Federation of Neurological Societies. 2019;26(4):617–23.

50. EuropeanMedicinesAgency. CMDh agrees to strengthen warnings on the use of valproate medicines in women and girls: European Medicines Agency; 2014 [30.01.2017]. Available from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2014/11/news_detail_002220.jsp&mid=WC0b01ac058004d5c1.