Student The University of Manitoba University of Manitoba Winnipeg, Canada
Background: Antiseizure medication (ASM) exposure in utero is associated with an increased risk of adverse birth outcomes. Evidence of neonatal adverse outcomes due to epilepsy itself is scarce.
Objectives: We aim to study the association between ASM treatment during pregnancy and adverse neonatal outcomes in all exposed and pregnant people with epilepsy (PPWE).
Methods: We conducted a population-based cohort study among pregnant people in Manitoba, Canada, from 1998 to 2019. We examined the association between ASMs and the risk of small for gestational age (SGA), low birth weight (LBW), preterm birth, NICU admissions, maternal length of hospital stay (LOS) (>3days), LOS infants, infant mortality (≤27), neonatal mortality (≤365 days), and neonatal readmissions in all pregnant people and PPWE. Multivariate regression models were adjusted for maternal age, pain diagnoses, psychiatric disorders, diabetes, hypertension, maternal age, urban/rural, socio-economic status, and teratogenic drugs.
Results: We included 272,205 pregnancies, including 3,691 ASM-exposed pregnancies, of which 798 pregnancies were in PPWE. In pregnant people exposed to ASMs, we observed a significant increased risk of SGA (adjusted odds ratio [aOR] 1.15, 95%CI 1.02-1.29), LBW (aOR 1.58, 95%CI 1.40-1.79), preterm birth (aOR 1.54, 95%CI 1.42-1.67), NICU admissions (aOR 1.98, 95%CI 1.79-2.18), LOS mother (aOR 1.21, 95%CI 1.12-1.31), LOS infant (aOR 1.65, 95%CI 1.58-1.79) and a non-significant increase in the risk of infant mortality (aOR 1.23, 95%CI 0.89-1.83), neonatal mortality (aOR 1.38, 95%CI 0.86-2.22) and neonatal readmissions (aOR 1.05, 95%CI 0.88-1.27) when compared with unexposed pregnant people. Similar trends of increased risk were found among PPWE, but none reached statistical significance.
Conclusions: ASM exposure in pregnant people was associated with a significant increase in adverse birth outcomes in infants. It is unclear whether there were risks associated with PPWE as the analysis was likely underpowered. Larger studies among PPWE are recommended to better identify the separate effect of ASMs from underlying epilepsy.
.jpg "Alekhya Lavu, PharmD, Ph.D candidate photo")
