Pregnancy with epilepsy: Obstetric and neonatal outcome of a controlled study

Purpose: To determine the influence of epilepsy and its treatment on pregnancy and its outcome. Design: Controlled, observational study. Setting: National Health Service maternity hospitals in Liverpool and Manchester regions. Population: 277 women with epilepsy (WWE) and 315 control women. Methods: WWE were recruited from antenatal clinics. Controls were matched for age and parity but not gestational age. Information was obtained by interview and from clinical records. Main outcome measures: Obstetric complications, mode of delivery, condition of newborn. Results: Distribution of epilepsy syndromes was similar to previous surveys. Most WWE (67%) received monotherapy with carbamazepine, sodium valproate or lamotrigine. Half WWE had no seizures during pregnancy but 34% had tonic clonic seizures. Seizure-related injuries were infrequent. Pregnancies with obstetric complications were increased in women with treated epilepsy (WWTE 45%, controls 33%; p = 0.01). Most had normal vaginal delivery (WWTE 63%, controls 61%; p = 0.65). Low birth weight was not increased (WWTE 6.2%, controls 5.2%; p = 0.69). There were more major congenital malformations (MCM) (WWTE 6.6%, controls 2.1%; p = 0.02) and fetal/infant deaths (WWTE 2.2%, controls 0.3%; p = 0.09). Amongst monotherapies MCM prevalence was highest with valproate (11.3%; p = 0.005). Lamotrigine (5.4%; p = 0.23) and carbamazepine (3.0%; p = 0.65) were closer to controls (2.1%). There was no association between MCM and dose of folic acid pre-conception. Conclusion: MCM were more prevalent in the babies of WWTE particularly amongst those receiving sodium valproate. © 2009 British Epilepsy Association.