Abstracts

Rationale: Pregnancy in woman with epilepsy can give rise to several serious medical problems and always belongs to the group of high obstetric risks. The aim of the retrospective study was the evaluation of the efficiency of antiepileptic treatment during pregnancy, including risk factor, effects on pregnancy and delivery in pregnant women with epilepsy in Malta, a small island state with a population of 400,000, for the period, 1996 – 2005, compared with the general pregnant population receiving the same obstetric care.Methods: The medical and obstetric data records of mothers with epilepsy (PWE) who gave birth between January 1996 and December 2005 in Malta was reviewed from the 120 Monthly Birth Registers for the period 1996 - 2005 together with Malta Congenital Anomalies Register for the same period. Data obtained was statistically analysed and compared to that of the whole population. The study methodology used was adapted to the methodology used in similar investigations carried out by Richmond et al (2004) in Quebec. Results: The data obtained was analysed using BPMP® statistical package, with student t-tests at the 5 % significant level. In total, 58 birth outcomes in 46 PEW were documented i.e 0.1% of total births during that time. The epilepsy was idiopathic in 42 cases. In 5 cases, the PEW were not taking any AEDs. All PEW were on folic acid 5 mg daily. CBZ (n = 29) and PHT (n = 21) were the two most widely prescribed AEDs in this group: 60% were on monotherapy, while 22% on two drugs, 9% on 3 drugs and 9% were on no treatment. Birth weight (3.29 + 1.25 kg; p > 0.05), AGPAR scores (8.2 vs 8.25; p>0.05) and incidence of congenital anomalies fitted in with the general population, but there was a higher incidence of obstetric intervention in PWE (normal vaginal delivery 50 % vs 74.8 %); P <0.05). Conclusions: The study population was too small to draw more statistically significant conclusions. Further studies to assess the level of risk of adverse outcomes over a longer follow up period are necessary. Setting up local prospective ongoing studies amongst PWE in a pregnancy registry in a small population can contribute to the pooling of data to larger international data centres. It is only with the emergence of solid evidence of the difference in the teratogenicity of AEDs, which may change current practice in the management of epilepsy in women of childbearing potential. The systematic monitoring of pregnancy outcomes after exposure will yield important information for the medical community.