National Cheng Kung University Tainan City , Taiwan
Background: Using antiepileptic drugs (AEDs) for active pregnant women with epilepsy (WWE) can effectively control seizure attack. The benefit and risk of AEDs should be considered in WWE with pre-existing mental health disorders.
Objectives: This study was to evaluate the impact of psychiatric diseases and AEDs utilization on adverse pregnant outcomes in WWE by using linked database in Taiwan.
Methods: We identified a cohort of pregnancy women with active epilepsy in 2009 to 2018 by linking three databases (Maternal and Child Health Database, National Health Insurance Database, and Birth Certificate Database). Active epilepsy was defined as pregnant WWE with at least two epilepsy visits on separate date or at least one hospitalization of epilepsy or had at least one AEDs prescriptions within two years prior to conception. WWE with major depression disorder, bipolar disorder, schizophrenia, sleep disorder and anxiety diagnosis were defined as with psychiatric comorbidities. Prenatal outcomes which included premature rupture of membrane, fetal distress, antepartum hemorrhage and pre-eclampsia/eclampsia and birth outcomes such as maternal complications in delivery, low birth weight, very low birth weight, preterm birth ( < 37 weeks), low Apgar score ( < 7), congenital malformations were evaluated as composite adverse pregnant outcomes. The primary analysis was to compare the risk of adverse outcome between AEDs exposure and non-exposure and stratified by psychiatric disease. We conducted a sensitivity analysis to redefined active epilepsy within 6 months period.
Results: There were 1,262 and 1,230 pregnant women met study criteria in exposure and non-exposure group, respectively. Compared to non-exposure group, the adjusted odds ratio for composite adverse outcome in exposure group was 0.98 [95% CI: 0.84-1.15]. Compared to non-exposure WWE without psychiatry, AEDs exposure WWE with psychiatry was not increase risk of adverse outcome (aOR=1.07 [95% CI: 0.84-1.35]). The stratified analysis showed that the risk was significantly lower in AED exposures than non-exposures among psychiatric subgroup (aOR=0.75, [95% CI:0.60-0.94]. Among non-psychiatric subgroup, AED exposure had marginal higher risk of adverse outcome than non-exposure ones (aOR=1.13, [95% CI:0.79-1.60]) Further sensitivity analysis showed similar results.
Conclusions: Stratified analysis showed that the risk of adverse outcomes of AEDs exposure was different among with/without psychiatric disease. Further study to analyze the interaction between a AEDs exposure and psychiatric disease is needed.
