Abstracts

Rationale: Antiepileptic drugs (AEDs) are commonly prescribed to women of childbearing age. Prenatal exposure to AEDs is related to an increased incidence in congenital malformations, lower IQ, and other adverse effects on the fetus. Between 0.3% and 0.7% of all pregnancies are in women with epilepsy (WWE). Despite it's possible teratogenicity, treatment in epilepsy generally cannot be withdrawn even when pregnancy is planned, because uncontrolled seizures might harm the mother and fetus and can occasionally be fatal. The goal of physicians treating pregnant epileptic women is to achieve a delicate balance between the safety of the mother and the unborn offspring. This task is often a challenging one. Many studies tried to assess the risk of teratogenicity of the different AED and the effect of dosage and different regimens. Most studies assessed pregnancy outcome according to living births outcomes\. A fraction of pregnancies is terminated by therapeutic abortions and not by living birth, thus reducing the calculated incidence of congenital malformations and possibly influence of AED exposure. Data collected of WWE admitted for labor might give only partial information on AEDs effect since a part of pregnancies might have been terminated before labor. Aim of study: Description of indication of TOP in WWE and possible influence of AED exposure on TOP. Methods: Records of all WWE who underwent TOP at Rabin Medical Center, Campus Beilinson between the years 2005 and 2016 were reviewed for indication of TOP, epilepsy type, seizure frequency and concurrent AED use before TOP. Results: 47 patients with a diagnosis of epilepsy and TOP were included. 58 TOP occurred during the study period (TOP/patient: one: n=40; two: n=5; three: n=1; five: n=1). Average age was 32.5 ±6.0 y. Most women were described as having generalized seizures (n=30, 63.8%). Focal seizures were described in n=9, 19.1% and unknown in n=8, 17.0%. Age of diagnosis of Epilepsy was 15.2 ±7.8 y (range: 1-40y of age) and on average 16.7 ±9.5 years before the TOP (range: 1-39 years).Seizure freedom during at least one year before the TOP was recorded in 25 patients (43.1%) and seizures did occur in another 25 cases (43.1%; unknown: n=8, 13.8%). In those WWE with seizures in the year before TOP, seizure frequency was 1-2/ year in n=15 (25.9%); 3-10/year: n=1 (1.7%); >10/y: n=9 (15.5%).84.5% (n=49) of all WWE were treated with AEDs at the time of TOP (untreated: n=4, 6.7%; unknown: n=5, 8.6%). AEDs used were CBZ (n=16; 27.6%), VPA (n=12; 20.7%), LTG (n=10; 17.2%), TPX (n=5; 8.5%), Clonazepam (n=3; 5.2%), and GBP, LVT, PBP (each n=1; 1.7%).Most TOPs occurred in the first trimester (n=37, 72.6%; second trimester: n=13, 25.5%; third trimester: n=1, 1.9%). Average gestational week 11.0 ±4.8 weeks.The most common indications were missed abortion and incomplete abortion (n=28, 48.3%). Other indications were major malformation on ultra sound (n=3, 5.2%), AED exposure (n=5, 8.6%), patient request (n=9, 15.5%), uncontrolled epilepsy (n=4, 6.9%), medical indication (n=2, 3.4%) and unknown reasons (n=7, 12.0%).Regarding only induced TOPs (not spontaneous or missed abortions), the patient request for TOP was the leading cause (30%) followed by AED exposure (16.6%), major malformation (10%), and medical indications (6.7%; unknown reason: 23.3%). Conclusions: Termination of pregnancy (TOP) in women with epilepsy (WWE) is commonly ignored and even though the effect of AEDs on pregnancy outcomes is studied widely, TOP is frequently not mentioned. In a retrospective analysis of WWE after TOP we show that TOP is not uncommon and the decision for TOP seems not to be influenced by the type of AED or the seizure frequency. Funding: None