Objectives

Pregnancy registries for women with epilepsy (WWE) are arising all over the world. The aim of this work was to assess the risk factors of pregnancy losses and major birth defects (MBDs) of WWE through the Egyptian Registry of Anti-seizure medications and Pregnancy system.

Methods

An observational prospective study was conducted over 24 months (2018–2020). The following data were assessed: seizure control during pregnancy, Anti-seizure medications (ASMs) regimen, folic acid supplementation, and birth outcome.

Results

This study included 211 pregnant WWE, with mean age of 27.30 ± 5.51 years. One hundred eighty-six (89.9%) patients were on ASMs, from which 110 (59.1%) patients were on monotherapy. One hundred sixty-nine (80.0%) had healthy living babies, while fetal deaths occurred in 27 patients (12.8%) (25 abortions and 2 stillbirth), two patients (1%) had neonatal deaths, while 13 patients (6.2%) had living babies with MBDs. Although taking folic acid in the first trimester was a protective of fetal deaths (RR < 1, P 0.011), it was not a protective of MBDs. Seizure freedom during the entire pregnancy regardless of seizure type was another protective factor against fetal deaths (RR < 1, P < 0.001). Polytherapy exposure significantly increased the risk of MBDs compared with monotherapies (RR > 1, P 0.014). History of previous MBD was another risk factor of MBDs (RR > 1, P 0.027).

Conclusion

History of previous MBD and polytherapy exposure increased the risk of MBDs. Taking folic acid during first trimester and being seizure free during pregnancy were protective factors against fetal deaths.

中文翻译：

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癫痫妇女新生儿胎儿死亡和主要出生缺陷的危险因素：埃及前瞻性研究

目标

全世界都在为患有癫痫症 (WWE) 的女性进行妊娠登记。这项工作的目的是通过埃及抗癫痫药物登记处和妊娠系统评估 WWE 流产和主要出生缺陷 (MBD) 的风险因素。

方法

一项观察性前瞻性研究进行了 24 个月（2018-2020 年）。评估了以下数据：怀孕期间的癫痫控制、抗癫痫药物 (ASM) 方案、叶酸补充剂和出生结果。

结果

该研究包括 211 名怀孕的 WWE，平均年龄为 27.30 ± 5.51 岁。186 (89.9%) 名患者接受 ASM，其中 110 (59.1%) 名患者接受单药治疗。169 例 (80.0%) 生出健康婴儿，27 例 (12.8%) 发生胎儿死亡（25 例流产和 2 例死产），2 例（1%）新生儿死亡，13 例（6.2%）有患有 MBD 的活婴儿。尽管在孕早期服用叶酸对胎儿死亡有保护作用（RR < 1，P 0.011），但对 MBD 没有保护作用。无论癫痫发作类型如何，在整个妊娠期间无癫痫发作是防止胎儿死亡的另一个保护因素（RR < 1，P  < 0.001）。与单一疗法相比，多疗法暴露显着增加了 MBD 的风险（RR > 1，P 0.014）。既往 MBD 病史是 MBD 的另一个危险因素（RR > 1，P = 0.027）。

结论

既往 MBD 和多药治疗暴露史增加了 MBD 的风险。在头三个月服用叶酸和在怀孕期间没有癫痫发作是防止胎儿死亡的保护因素。