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

PLoS One. 2024 Apr 1;19(4):e0291190. doi: 10.1371/journal.pone.0291190. eCollection 2024.

Abstract

This retrospective cohort study described the obstetric and neonatal outcomes, antiseizure medication (ASM) use, and types of seizures in pregnant women with epilepsy (PWWE). Data collected from the medical records of 224 PWWE aged < 40 years with controlled or refractory seizures and 492 pregnant women without epilepsy (PWNE) control group from high-risk maternity hospitals in Alagoas between 2008 and 2021 were included in this study. The obstetric and neonatal outcomes observed in PWWE were pregnancy-related hypertension (PrH) (18.4%), oligohydramnios (10.3%), stillbirth (6.4%), vaginal bleeding (6%), preeclampsia (4.7%), and polyhydramnios (3%). There was a greater likelihood of PrH in PWWE with generalized tonic-clonic seizures (GTCS) and that of maternal intensive care unit (ICU) admissions in those with GTCS and status epilepticus, and phenytoin and lamotrigine use. PWWE with GTCS had a higher risk of stillbirth and premature delivery. PWWE with status epilepticus were treated with lamotrigine. Phenobarbital (PB) with diazepam were commonly used in GTCS and status epilepticus. Total 14% patients did not use ASM, while 50.2% used monotherapy and 35.8% used polytherapy. Total 60.9% of patients used PB and 25.2% used carbamazepine. This study described the association between the adverse obstetric and neonatal outcomes and severe seizure types in PWWE.

MeSH terms

  • Anticonvulsants / adverse effects
  • Brazil / epidemiology
  • Epilepsy* / drug therapy
  • Female
  • Humans
  • Infant, Newborn
  • Lamotrigine / therapeutic use
  • Phenobarbital / therapeutic use
  • Pregnancy
  • Pregnant Women
  • Retrospective Studies
  • Seizures / chemically induced
  • Seizures / drug therapy
  • Seizures / epidemiology
  • Status Epilepticus* / chemically induced
  • Stillbirth / epidemiology

Substances

  • Lamotrigine
  • Anticonvulsants
  • Phenobarbital

Grants and funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.