Abstract：
BACKGROUND: Adequate pre-pregnancy counselling and education planning are essential to improve outcomes for offspring of women with epilepsy (OWWE). The current systematic review and meta-analysis aimed to compare outcomes for OWWE and offspring of women without epilepsy (OWWoE).
METHODS: We conducted a systematic review and meta-analysis. We searched MEDLINE, EMBASE, CINAHL, PsycINFO (database inception-1st January 2023), OpenGrey, GoogleScholar, and hand-searched journals and reference lists of included studies to identify eligible studies. We placed no language restrictions and included observational studies concerning OWWE and OWWoE. We followed the PRIMSA checklist for abstracting data. The Newcastle-Ottawa Scale for risk of bias assessment was conducted independently by two authors with mediation by a third. We report pooled unadjusted odds ratios (OR) or mean differences (MD) with 95% confidence intervals (95CI) from random (I2>50%) or fixed (I2<50%) effects meta-analyses. Outcomes of interest included offspring autism, attention deficit/hyperactive disorder, intellectual disability, epilepsy, developmental disorder, intelligence, educational, and adulthood socioeconomic outcomes.
RESULTS: Of 10,928 articles identified, we included 21 in meta-analyses. OWWE had increased odds of autism (2 articles, 4,502,098 offspring) OR [95CI] 1·67 [1·54, 1·82], attention-deficit/hyperactivity disorder (3 articles, 957,581 offspring) 1·59 [1·44, 1·76], intellectual disability (2 articles, 4,501,786 children) 2·37 [2·13, 2·65], having special educational needs (3 articles, 1,308,919 children) 2·60 [1·07, 6·34]. OWWE had worse mean scores for full-scale intelligence (5 articles, 989 children) -6·05 [-10·31, -1·79]. No studies were identified that investigated adulthood socioeconomic outcomes.
CONCLUSIONS: Increased odds of poor outcomes are higher with greater anti-seizure medication burden including neurodevelopmental and educational outcomes. In fact, these two outcomes seem to be worse in OWWE compared to OWWoE, even if there was no ASM exposure during pregnancy, but further work is needed to take into account potential confounding factors.
METHODS: We conducted a systematic review and meta-analysis. We searched MEDLINE, EMBASE, CINAHL, PsycINFO (database inception-1st January 2023), OpenGrey, GoogleScholar, and hand-searched journals and reference lists of included studies to identify eligible studies. We placed no language restrictions and included observational studies concerning OWWE and OWWoE. We followed the PRIMSA checklist for abstracting data. The Newcastle-Ottawa Scale for risk of bias assessment was conducted independently by two authors with mediation by a third. We report pooled unadjusted odds ratios (OR) or mean differences (MD) with 95% confidence intervals (95CI) from random (I2>50%) or fixed (I2<50%) effects meta-analyses. Outcomes of interest included offspring autism, attention deficit/hyperactive disorder, intellectual disability, epilepsy, developmental disorder, intelligence, educational, and adulthood socioeconomic outcomes.
RESULTS: Of 10,928 articles identified, we included 21 in meta-analyses. OWWE had increased odds of autism (2 articles, 4,502,098 offspring) OR [95CI] 1·67 [1·54, 1·82], attention-deficit/hyperactivity disorder (3 articles, 957,581 offspring) 1·59 [1·44, 1·76], intellectual disability (2 articles, 4,501,786 children) 2·37 [2·13, 2·65], having special educational needs (3 articles, 1,308,919 children) 2·60 [1·07, 6·34]. OWWE had worse mean scores for full-scale intelligence (5 articles, 989 children) -6·05 [-10·31, -1·79]. No studies were identified that investigated adulthood socioeconomic outcomes.
CONCLUSIONS: Increased odds of poor outcomes are higher with greater anti-seizure medication burden including neurodevelopmental and educational outcomes. In fact, these two outcomes seem to be worse in OWWE compared to OWWoE, even if there was no ASM exposure during pregnancy, but further work is needed to take into account potential confounding factors.
摘要：
背景：适当的孕前咨询和教育计划对于改善癫痫妇女（OWWE）后代的结局至关重要。当前的系统评价和荟萃分析旨在比较OWWE和无癫痫女性后代的结局（OWWoE）。
方法：我们进行了系统评价和荟萃分析。我们搜索了MEDLINE,EMBASE,CINAHL,PsycINFO（数据库开始-2023年1月1日），OpenGrey,GoogleScholar,以及手工检索的期刊和纳入研究的参考列表，以确定符合条件的研究。我们没有语言限制，包括关于OWWE和OWWoE的观察性研究。我们遵循PRIMSA清单来抽象数据。纽卡斯尔-渥太华偏见风险评估量表由两名作者独立进行，并由三分之一进行调解。我们报告了来自随机（I2>50％）或固定（I2<50％）效应荟萃分析的合并未调整比值比（OR）或平均差（MD）和95％置信区间（95CI）。感兴趣的结果包括后代自闭症，注意缺陷/多动症，智力残疾,癫痫,发育障碍,情报,教育,和成年后的社会经济结果。
结果：在确定的10,928篇文章中，我们在荟萃分析中纳入了21项.OWWE患自闭症的几率增加(2篇文章，4,502,098个后代）或[95CI]1·67[1·54，1·82]，注意力缺陷/多动障碍(3篇文章，957,581个后代）1·59[1·44，1·76]，智力残疾(2篇文章，4,501,786名儿童）2·37[2·13，2·65]，有特殊教育需要(3条，1,308,919名儿童）2·60[1·07，6·34]。OWWE的全面智力平均得分更差(5篇文章，989名儿童）-6·05[-10·31，-1·79]。没有确定调查成年社会经济结果的研究。
结论：随着包括神经发育和教育结果在内的抗癫痫药物负担增加，不良结局的几率增加。事实上,与OWWE相比，这两个结果在OWWE中似乎更糟，即使怀孕期间没有ASM暴露，但是需要进一步的工作来考虑潜在的混杂因素。
方法：我们进行了系统评价和荟萃分析。我们搜索了MEDLINE,EMBASE,CINAHL,PsycINFO（数据库开始-2023年1月1日），OpenGrey,GoogleScholar,以及手工检索的期刊和纳入研究的参考列表，以确定符合条件的研究。我们没有语言限制，包括关于OWWE和OWWoE的观察性研究。我们遵循PRIMSA清单来抽象数据。纽卡斯尔-渥太华偏见风险评估量表由两名作者独立进行，并由三分之一进行调解。我们报告了来自随机（I2>50％）或固定（I2<50％）效应荟萃分析的合并未调整比值比（OR）或平均差（MD）和95％置信区间（95CI）。感兴趣的结果包括后代自闭症，注意缺陷/多动症，智力残疾,癫痫,发育障碍,情报,教育,和成年后的社会经济结果。
结果：在确定的10,928篇文章中，我们在荟萃分析中纳入了21项.OWWE患自闭症的几率增加(2篇文章，4,502,098个后代）或[95CI]1·67[1·54，1·82]，注意力缺陷/多动障碍(3篇文章，957,581个后代）1·59[1·44，1·76]，智力残疾(2篇文章，4,501,786名儿童）2·37[2·13，2·65]，有特殊教育需要(3条，1,308,919名儿童）2·60[1·07，6·34]。OWWE的全面智力平均得分更差(5篇文章，989名儿童）-6·05[-10·31，-1·79]。没有确定调查成年社会经济结果的研究。
结论：随着包括神经发育和教育结果在内的抗癫痫药物负担增加，不良结局的几率增加。事实上,与OWWE相比，这两个结果在OWWE中似乎更糟，即使怀孕期间没有ASM暴露，但是需要进一步的工作来考虑潜在的混杂因素。
