(144) Antiseizure medication safety in pregnant people for non-epilepsy conditions

Publication Number: 1139

Background: Antiseizure medication (ASM) exposure in utero has been associated with an increased risk of adverse birth outcomes.

Objectives: With the increase in the use of ASMs for off-label indication in the last two decades, there is a need for ASMs safety research in pregnant people without epilepsy (PPWOE).

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, length of hospital stay (LOS) (> 3 days) in mothers, LOS infants, infant mortality (≤27), neonatal mortality (≤365 days), and neonatal readmissions in PPWOE. Multivariate regression models were adjusted for pain diagnoses, psychiatric disorders, diabetes, hypertension, urban/rural, socio-economic status and teratogenic drugs

Results: We analyzed 2893 ASMs exposed PPWOE and 267712 unexposed pregnant people. In ASMs exposed PPWOE, we found a significant increased risk of LBW (aOR 1.54, 95%CI 1.34-1.08), preterm birth (aOR 1.52, 95%CI 1.35-1.71), NICU admissions (aOR 1.96, 95%CI 1.76-2.18), LOS(mother) (aOR 1.14, 95%CI 1.04-1.25), LOS (Infant) (aOR 1.61, 95%CI 1.47-1.76) and a non-significant increase in SGA (aOR 1.13, 95%CI 0.99-1.28), infants mortality (aOR 1.22, 95%CI 0.78-1.92), neonatal mortality (aOR 1.32, 95%CI 0.76-2.29) and neonatal readmissions (aOR 1.05, 95%CI 0.85-1.28) when compared with unexposed pregnant people.

Conclusions: ASMs exposure was associated with an increased risk of several adverse birth outcomes in PPWOE. Therefore, prescription of ASMs for non-epilepsy indication must be rationalized, especially when alternate treatments can be safer for pregnant people.