Abstracts

Rationale: Epilepsy in pregnancy can be challenging as both antiepileptic drugs (AEDs) and convulsive seizures may harm the foetus. In recent studies, an increased occurrence of induced labor, caesareans, preeclampsia, preterm delivery and early vaginal bleeding have been reported in women with epilepsy (WWE). Oligohydramnios, often associated with foetal distress and intrauterine growth retardation, has to our knowledge not been studied in this population. This report assesses the frequency of complications during pregnancy and delivery in WWE based on data from a prospective database. Methods: Information on pregnant women giving birth in Oppland County, Norway, in the period 1989-2012 was prospectively registered in The Oppland Perinatal Database (OPD). The OPD includes more than 40　000 pregnancies and births, i.e. 95% of all women giving birth in Oppland county. Demographic and medical information was systematically collected in conjunction with the routine ultrasound examination (week 17-19), and at birth. The epilepsy diagnose was validated by a neurologist (AHF) by evaluation of medical history in the medical records and EEG-exams. A total of 173 women with ongoing or previous epilepsy were identified. Seven women refused inclusion, making 166 women and 292 children eligible for analysis. Results: Mean age WWE 27.8 (range 16-39), controls 28.8 (range 13-48) (p=0.001). 49.5% were classified as focal epilepsy, 30% generalized, 31.5% unclassified. In 292 pregnancies, 160 (54.8%) women used AEDs during the pregnancy. 39% used carbamazepine, 19% valproate, 14% lamotrigine, and 15% were on polytherapy. Seizures, mostly generalized tonic clonic, were noted in 15 % of the pregnancies. Four women experienced seizures in connection with labor. There were significantly higher occurrence of oligohydramnios and diabetes among the women with epilepsy. Regarding preeclampsia, hypertension, anemia, bleeding during pregnancy, breech presentation, duration of labor, caesareans or labor inductions there were no significant differences between the epilepsy group and non-epilepsy group, see table 1. Among women using AEDs there was a non-significant trend towards more caesareans (17.2%, p .36), inductions (15.9%, p.13), congenital malformations (3.2%, p.11), bleedings (5.7%, p=.45) and discoloured amniotic fluid (24.5%, p=.072). Diabetes and oligohydramnios was significantly more common in the AED treated group (3.2% p.014, and 7.6%, p=.026, respectively). Conclusions: The general risk of obstetric complications during pregnancy in the current cohort appears smaller than previously reported. The WWE in OPD seem to be well controlled as seizures were noted in only 15 % of the pregnancies. AEDs were used in 54.8% of the pregnancies. The occurrence of olighydramnios and maternal diabetes was significantly higher in the WWE than in the controls.