Obstetric and neonatal outcomes: antiseizure medication profile and seizure types in pregnant women in a vulnerability state, Brazil

Abstract

Abstract Objectives To describe obstetric and neonatal outcomes, the profile of antiseizure medication (ASM), and types of seizures in pregnant women with epilepsy (PWWE) in Alagoas. Methods In this retrospective cohort study using data collected from the medical records of PWWE and pregnant women without epilepsy (control group) between 2008 and 2020, PWWE/PWNE aged < 40 years (controlled seizures or refractory epilepsy) were included. Medical records were obtained from high-risk maternity hospitals in Alagoas. Results The obstetric and neonatal outcomes observed in PWWE were pregnancy-related hypertension (PrH) (odds ratio [OR] = 6.29; 95% confidence interval (CI) = 3.50–11.30), vaginal bleeding (OR = 2.54; 95% CI = 1.15–5.59), preeclampsia (OR = 8.04; 95% CI = 2.22–29.10), oligohydramnyos OR = 4,57; 95% CI = 2.24–9,31), polyhydramnios (OR = 7.55; 95% CI = 1.55–36.65), miscarriage (OR = 1.75;95% CI = 1.16–2.63), stillbirth (OR = 11,16; 95% CI = 2.22–29.10), greater likelihood of PrH in those with generalized tonic-clonic seizures (GTCS) (OR = 8.05; 95% CI = 3.47–18.64), greater likelihood of maternal ICU admission in those with GTCS and status epilepticus (OR = 11.73; 95% CI = 2.44–56.37 vs. OR = 37.50; 95% CI = 8.32–168.84, respectively) and phenytoin and lamotrigine use (OR = 17.75; 95% CI = 1.95–160.77 vs. OR = 7.10; 95% CI = 1.03–48.64). PWWE with GTCS had a higher chance for stillbirth (OR = 3.41; 95% CI = 1.03–11.28). and status epilepticus were more likely to deliver prematurely (OR = 2.22; 95% CI = 1.05–4.69). PWWE with status epilepticus had higher odds of using lamotrigine (OR = 21,91; 95% CI = 2.07–231.60). Phenobarbital(PB) with diazepam was the most commonly used drug by PWWE with GTCS and status epilepticus (OR = 12.04; 95% CI = 1.43–101.47). Only 14% of PWWE did not use, 50.2% used monotherapy, and 35.8% used polytherapy. Phenobarbital was the most commonly used ASM (60.9%), followed by carbamazepine (25.2%). Conclusion This study described adverse obstetric and neonatal outcomes in PWWE. Many pregnant women with epilepsy used ASM, showing a positive association with adverse outcomes and more severe seizure types.