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.