Brynhildur K. Asgeirsdottir1

Sigridur Margret Thorbergsdottir2

Haukur Hjaltason3,4

Agust Hilmarsson3

Thora Steingrimsdottir1,4

 

1Department of Obstetrics and Gynecology, Landspitali – The National University Hospital of Iceland, 2Department of Psychiatry, Landspitali – The National University Hospital of Iceland, 3Department of Neurology, Landspitali – The National University Hospital of Iceland, 4Faculty of Medicine, University of Iceland

 

Correspondence: Brynhildur K. Asgeirsdottir, brynhias@landspitali.is

 

 

Key words: epilepsy, pregnancy, antiepileptic drugs, maternal outcome, fetal outcome

Introduction: Epilepsy is one of the most common chronic illnesses among women of childbearing age, and it is known that antiepileptic drugs can be teratogenic. Recommendations for the treatment of women with epilepsy during pregnancy focus on minimizing the risk of seizures and fetal damage. In general, changes in antiepileptic treatment are not recommended, except to avoid the use of valproate, and the use of high-dose folic acid is advised before and during pregnancy. This article describes the results of a study on the outcomes of pregnancy and childbirth in women with epilepsy on anti-epileptic treatment in Iceland from 2011 to 2020.

Materials and methods: A retrospective, matched case-control study over a 10-year period. Data were obtained from the Icelandic Medical Birth Registry and the Prescription Database of the Directorate of Health. Statistical analysis was based on t-tests, Wilcoxon tests, chi-square tests, and Fisher test, and a linear mixed model was used in cases where adjustment was made for confounding factors.

Results: The study group included 107 births, and 202 in the control group. Women with epilepsy attended more frequent antenatal visits and had higher rates of labor induction, cesarean section and use of anesthesia during labor. There was no difference in mean gestational age, mean labor duration, mean blood loss during labor, or median Apgar score between the groups. Use of antiepileptic medication was lower during pregnancy than before, mainly due to reduced use of valproate.

Conclusions: Pregnancy and delivery outcomes of women with epilepsy were generally favorable. There was no increased risk of serious complications in pregnancy and labor, nor congenital anomalies or deviations in the newborns. We consider our results important for women with epilepsy in Iceland, as well as for doctors and other health care professionals providing their care.