Fellow in Epilepsy FLENI Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
This abstract has been invited to present during the Better Patient Outcomes through Diversity Platform poster session
Rationale: To analyze how pregnancy affects patients with epilepsy, in terms of their seizure frequency, antiepileptic drugs (AEDs) used and to describe the effects of epilepsy on pregnancy, maternal complications and fetal malformations. Methods: Retrospective and descriptive study. We included patients with epilepsy from our institution who were pregnant between 2001 and 2019. The following variables were analyzed: demographic of the mother and newborn, type of epilepsy, seizure frequency, DAES used, maternal and fetal complications. Results: Two hundred fifteen pregnancies were analyzed, of which we followed up until delivery in 167 of them, corresponding to 125 patients. The average maternal age was 31 years. 43.2% of the patients had generalized epilepsy and 56.8% focal. Of 71 patients with focal epilepsy, 24 were symptomatic (7 Vascular, 6 Mesial temporal sclerosis, 3 Tumor, 3 Trauma, 3 dysplasia, 2 infectious). 53.9% of the pregnancies were scheduled with previous folic acid use. Seizure frequency did not change in 80.2% of the pregnancies, increased in 10.8% (72.2% of these patients presented focal epilepsy) and decreased in 9%. At the time of pregnancy, 77.8% of the patients were on monotherapy, 20.9% on polytherapy (maximum 4 AEDs) and 1.2% without medication. Of the pregnancies under monotherapy, 29 used valproic Acid (VPA) (average dose - AVD-: 700 mg), two phenytoin (PHT) (AVD 300 mg), 14 carbamazepine (CBZ) (AVD 700 mg), 4 phenobarbital (PB) (AVD 100 mg), 25 oxcarbazepine (OXC) (AVD 1100 mg), two topiramate (TPM) (AVD 200 mg), 26 lamotrigine (LTG) (AVD 250 mg), 20 levetiracetam (LEV) (AVD 1500mg), five clobazam (CLB) (AVD 10 mg) and three Clonazepam (CLZ) (AVD 4.5 mg). Maternal complications during pregnancy included five patients with gestational hypertension, four with metrorrhagia, three with preeclampsia, two with gestational diabetes and one with cholestasis. There were no maternal deaths among our patients. 27 spontaneous abortions occurred (16.2%), only four patients had antiphospholipid syndrome and three were in polytherapy. Of 140 deliveries, 41 were spontaneous, 88 by cesarean section, 11 without information. Eight of the newborns were premature: four of them were in UCI, one because of respiratory distress, one hypotonia, one in control and one died within hours of birth. Malformations were present in 3.6% of the newborns: one short frenulum + respiratory distress + maturational delay (VPA), one Interventricular communication (VPA /PB + CLB), one hypospadias (CBZ), one pinna malformation (OXC). Conclusions: In our population, seizure frequency did not change in most patients. Patients who worsened their seizure frequency had focal epilepsy. There was a 9% rate of maternal complications during pregnancy. Most of the patients were on monotherapy by the time of pregnancy. In our group, 80% of the malformations occurred in patients that were on traditional AEDs, and the rest (20%) in patients that were on new AEDs. Pregnancy was scheduled and folic acid was used in more than half of the patients. In line with the literature, there was a low rate of malformations and the majority was reported in patients using traditional AEDs. In our population, LEV and LTG appear to be the safest AEDs, although requiring stringent monitoring with periodic dosages. Our work provides important background information to our patients regarding pregnancy and epilepsy and could help guide clinicians in choosing safer drugs and dose monitoring schemes. Funding: Please list any funding that was received in support of this abstract.: No funding was received.
