Fetal growth and premature delivery in pregnant women on antiepileptic drugs
Objective To evaluate the effects of epilepsy and antiepileptic drugs (AEDs) used during pregnancy on fetal growth and preterm delivery. Methods This study included singleton liveborn infants born to women enrolled in the North American Antiepileptic Drug Pregnancy Registry between 1997 and 2016. Da...
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| Veröffentlicht in: | Annals of neurology Jg. 82; H. 3; S. 457 - 465 |
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| Hauptverfasser: | , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
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United States
Wiley Subscription Services, Inc
01.09.2017
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| ISSN: | 0364-5134, 1531-8249, 1531-8249 |
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| Abstract | Objective
To evaluate the effects of epilepsy and antiepileptic drugs (AEDs) used during pregnancy on fetal growth and preterm delivery.
Methods
This study included singleton liveborn infants born to women enrolled in the North American Antiepileptic Drug Pregnancy Registry between 1997 and 2016. Data were collected prospectively through telephone interviews. The prevalence of preterm birth (<37 weeks) and small for gestational age status (SGA) among infants exposed prenatally to AEDs when used by women with epilepsy (WWE) or women without epilepsy (WWOE) was compared with that among infants unexposed to AEDs and born to WWOE. Multivariate log‐binomial regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs).
Results
The study population included infants born to 6,777 AED‐WWE, 696 AED‐WWOE, and 486 no‐AED‐WWOE. The risk of prematurity was 6.2% for no‐AED‐WWOE, 9.3% for AED‐WWE (RR = 1.5, 95% CI = 1.0–2.1), and 10.5% for AED‐WWOE (RR = 1.5, 95% CI = 1.0–2.4). Prenatal exposure to AEDs in WWE and WWOE was associated with a mean lower birth weight of 110 and 136g, respectively, as compared to no‐AED‐WWOE. The prevalence of SGA was 5.0% for no‐AED‐WWOE, 10.9% for AED‐WWE (RR = 2.0, 95% CI = 1.3–3.0), and 11.0% for AED‐WWOE (RR = 1.9, 95% CI = 1.2–2.9). Within users of AEDs in monotherapy, the prevalence of SGA ranged from 7.3% for lamotrigine to 18.5% for topiramate.
Interpretation
Women on AEDs during pregnancy, whether for epilepsy or for other neuropsychiatric indications, are at a higher risk of delivering prematurely and giving birth to SGA newborns. The risk may vary by drug. Ann Neurol 2017;82:457–465 |
|---|---|
| AbstractList | Objective
To evaluate the effects of epilepsy and antiepileptic drugs (AEDs) used during pregnancy on fetal growth and preterm delivery.
Methods
This study included singleton liveborn infants born to women enrolled in the North American Antiepileptic Drug Pregnancy Registry between 1997 and 2016. Data were collected prospectively through telephone interviews. The prevalence of preterm birth (<37 weeks) and small for gestational age status (SGA) among infants exposed prenatally to AEDs when used by women with epilepsy (WWE) or women without epilepsy (WWOE) was compared with that among infants unexposed to AEDs and born to WWOE. Multivariate log‐binomial regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs).
Results
The study population included infants born to 6,777 AED‐WWE, 696 AED‐WWOE, and 486 no‐AED‐WWOE. The risk of prematurity was 6.2% for no‐AED‐WWOE, 9.3% for AED‐WWE (RR = 1.5, 95% CI = 1.0–2.1), and 10.5% for AED‐WWOE (RR = 1.5, 95% CI = 1.0–2.4). Prenatal exposure to AEDs in WWE and WWOE was associated with a mean lower birth weight of 110 and 136g, respectively, as compared to no‐AED‐WWOE. The prevalence of SGA was 5.0% for no‐AED‐WWOE, 10.9% for AED‐WWE (RR = 2.0, 95% CI = 1.3–3.0), and 11.0% for AED‐WWOE (RR = 1.9, 95% CI = 1.2–2.9). Within users of AEDs in monotherapy, the prevalence of SGA ranged from 7.3% for lamotrigine to 18.5% for topiramate.
Interpretation
Women on AEDs during pregnancy, whether for epilepsy or for other neuropsychiatric indications, are at a higher risk of delivering prematurely and giving birth to SGA newborns. The risk may vary by drug. Ann Neurol 2017;82:457–465 To evaluate the effects of epilepsy and antiepileptic drugs (AEDs) used during pregnancy on fetal growth and preterm delivery.OBJECTIVETo evaluate the effects of epilepsy and antiepileptic drugs (AEDs) used during pregnancy on fetal growth and preterm delivery.This study included singleton liveborn infants born to women enrolled in the North American Antiepileptic Drug Pregnancy Registry between 1997 and 2016. Data were collected prospectively through telephone interviews. The prevalence of preterm birth (<37 weeks) and small for gestational age status (SGA) among infants exposed prenatally to AEDs when used by women with epilepsy (WWE) or women without epilepsy (WWOE) was compared with that among infants unexposed to AEDs and born to WWOE. Multivariate log-binomial regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs).METHODSThis study included singleton liveborn infants born to women enrolled in the North American Antiepileptic Drug Pregnancy Registry between 1997 and 2016. Data were collected prospectively through telephone interviews. The prevalence of preterm birth (<37 weeks) and small for gestational age status (SGA) among infants exposed prenatally to AEDs when used by women with epilepsy (WWE) or women without epilepsy (WWOE) was compared with that among infants unexposed to AEDs and born to WWOE. Multivariate log-binomial regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs).The study population included infants born to 6,777 AED-WWE, 696 AED-WWOE, and 486 no-AED-WWOE. The risk of prematurity was 6.2% for no-AED-WWOE, 9.3% for AED-WWE (RR = 1.5, 95% CI = 1.0-2.1), and 10.5% for AED-WWOE (RR = 1.5, 95% CI = 1.0-2.4). Prenatal exposure to AEDs in WWE and WWOE was associated with a mean lower birth weight of 110 and 136g, respectively, as compared to no-AED-WWOE. The prevalence of SGA was 5.0% for no-AED-WWOE, 10.9% for AED-WWE (RR = 2.0, 95% CI = 1.3-3.0), and 11.0% for AED-WWOE (RR = 1.9, 95% CI = 1.2-2.9). Within users of AEDs in monotherapy, the prevalence of SGA ranged from 7.3% for lamotrigine to 18.5% for topiramate.RESULTSThe study population included infants born to 6,777 AED-WWE, 696 AED-WWOE, and 486 no-AED-WWOE. The risk of prematurity was 6.2% for no-AED-WWOE, 9.3% for AED-WWE (RR = 1.5, 95% CI = 1.0-2.1), and 10.5% for AED-WWOE (RR = 1.5, 95% CI = 1.0-2.4). Prenatal exposure to AEDs in WWE and WWOE was associated with a mean lower birth weight of 110 and 136g, respectively, as compared to no-AED-WWOE. The prevalence of SGA was 5.0% for no-AED-WWOE, 10.9% for AED-WWE (RR = 2.0, 95% CI = 1.3-3.0), and 11.0% for AED-WWOE (RR = 1.9, 95% CI = 1.2-2.9). Within users of AEDs in monotherapy, the prevalence of SGA ranged from 7.3% for lamotrigine to 18.5% for topiramate.Women on AEDs during pregnancy, whether for epilepsy or for other neuropsychiatric indications, are at a higher risk of delivering prematurely and giving birth to SGA newborns. The risk may vary by drug. Ann Neurol 2017;82:457-465.INTERPRETATIONWomen on AEDs during pregnancy, whether for epilepsy or for other neuropsychiatric indications, are at a higher risk of delivering prematurely and giving birth to SGA newborns. The risk may vary by drug. Ann Neurol 2017;82:457-465. To evaluate the effects of epilepsy and antiepileptic drugs (AEDs) used during pregnancy on fetal growth and preterm delivery. This study included singleton liveborn infants born to women enrolled in the North American Antiepileptic Drug Pregnancy Registry between 1997 and 2016. Data were collected prospectively through telephone interviews. The prevalence of preterm birth (<37 weeks) and small for gestational age status (SGA) among infants exposed prenatally to AEDs when used by women with epilepsy (WWE) or women without epilepsy (WWOE) was compared with that among infants unexposed to AEDs and born to WWOE. Multivariate log-binomial regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). The study population included infants born to 6,777 AED-WWE, 696 AED-WWOE, and 486 no-AED-WWOE. The risk of prematurity was 6.2% for no-AED-WWOE, 9.3% for AED-WWE (RR = 1.5, 95% CI = 1.0-2.1), and 10.5% for AED-WWOE (RR = 1.5, 95% CI = 1.0-2.4). Prenatal exposure to AEDs in WWE and WWOE was associated with a mean lower birth weight of 110 and 136g, respectively, as compared to no-AED-WWOE. The prevalence of SGA was 5.0% for no-AED-WWOE, 10.9% for AED-WWE (RR = 2.0, 95% CI = 1.3-3.0), and 11.0% for AED-WWOE (RR = 1.9, 95% CI = 1.2-2.9). Within users of AEDs in monotherapy, the prevalence of SGA ranged from 7.3% for lamotrigine to 18.5% for topiramate. Women on AEDs during pregnancy, whether for epilepsy or for other neuropsychiatric indications, are at a higher risk of delivering prematurely and giving birth to SGA newborns. The risk may vary by drug. Ann Neurol 2017;82:457-465. Objective To evaluate the effects of epilepsy and antiepileptic drugs (AEDs) used during pregnancy on fetal growth and preterm delivery. Methods This study included singleton liveborn infants born to women enrolled in the North American Antiepileptic Drug Pregnancy Registry between 1997 and 2016. Data were collected prospectively through telephone interviews. The prevalence of preterm birth (<37 weeks) and small for gestational age status (SGA) among infants exposed prenatally to AEDs when used by women with epilepsy (WWE) or women without epilepsy (WWOE) was compared with that among infants unexposed to AEDs and born to WWOE. Multivariate log-binomial regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). Results The study population included infants born to 6,777 AED-WWE, 696 AED-WWOE, and 486 no-AED-WWOE. The risk of prematurity was 6.2% for no-AED-WWOE, 9.3% for AED-WWE (RR=1.5, 95% CI=1.0-2.1), and 10.5% for AED-WWOE (RR=1.5, 95% CI=1.0-2.4). Prenatal exposure to AEDs in WWE and WWOE was associated with a mean lower birth weight of 110 and 136g, respectively, as compared to no-AED-WWOE. The prevalence of SGA was 5.0% for no-AED-WWOE, 10.9% for AED-WWE (RR=2.0, 95% CI=1.3-3.0), and 11.0% for AED-WWOE (RR=1.9, 95% CI=1.2-2.9). Within users of AEDs in monotherapy, the prevalence of SGA ranged from 7.3% for lamotrigine to 18.5% for topiramate. Interpretation Women on AEDs during pregnancy, whether for epilepsy or for other neuropsychiatric indications, are at a higher risk of delivering prematurely and giving birth to SGA newborns. The risk may vary by drug. Ann Neurol 2017;82:457-465 |
| Author | McElrath, Thomas F. Pennell, Page B. Holmes, Lewis B. Yerby, Mark Hauser, W. Allen Hernández‐Díaz, Sonia |
| Author_xml | – sequence: 1 givenname: Sonia surname: Hernández‐Díaz fullname: Hernández‐Díaz, Sonia organization: Harvard T. H. Chan School of Public Health – sequence: 2 givenname: Thomas F. surname: McElrath fullname: McElrath, Thomas F. organization: Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital – sequence: 3 givenname: Page B. surname: Pennell fullname: Pennell, Page B. organization: Divisions of Epilepsy and Women's Health, Department of Neurology, Brigham and Women's Hospital – sequence: 4 givenname: W. Allen surname: Hauser fullname: Hauser, W. Allen organization: Columbia University – sequence: 5 givenname: Mark surname: Yerby fullname: Yerby, Mark organization: Oregon Health and Science University – sequence: 6 givenname: Lewis B. surname: Holmes fullname: Holmes, Lewis B. email: holmes.lewis@mgh.harvard.edu organization: North American Antiepileptic Drug Pregnancy Registry, MassGeneral Hospital for Children |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28856694$$D View this record in MEDLINE/PubMed |
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| Notes | This article is dedicated to Dr Autumn Klein, whose life was interrupted before she could complete this project for her patients. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 |
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| Snippet | Objective
To evaluate the effects of epilepsy and antiepileptic drugs (AEDs) used during pregnancy on fetal growth and preterm delivery.
Methods
This study... To evaluate the effects of epilepsy and antiepileptic drugs (AEDs) used during pregnancy on fetal growth and preterm delivery. This study included singleton... Objective To evaluate the effects of epilepsy and antiepileptic drugs (AEDs) used during pregnancy on fetal growth and preterm delivery. Methods This study... To evaluate the effects of epilepsy and antiepileptic drugs (AEDs) used during pregnancy on fetal growth and preterm delivery.OBJECTIVETo evaluate the effects... |
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| SubjectTerms | Adult Anticonvulsants - adverse effects Anticonvulsants - pharmacology Anticonvulsants - therapeutic use Antiepileptic agents Birth weight Childbirth & labor Confidence intervals Convulsions & seizures Drug delivery systems Drug development Drugs Epilepsy Epilepsy - drug therapy Female Fetal Development - drug effects Fetuses Gestational age Health risk assessment Humans Infant, Newborn Infant, Premature Infant, Small for Gestational Age Infants Lamotrigine Male Neonates Obstetric Labor, Premature - chemically induced Obstetric Labor, Premature - epidemiology Population studies Pregnancy Premature birth Prenatal experience Prenatal exposure Prevalence Prospective Studies Registries Regression analysis Regression models Risk Risk assessment Small for gestational age Topiramate Young Adult |
| Title | Fetal growth and premature delivery in pregnant women on antiepileptic drugs |
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