母亲癫痫与不良妊娠和新生儿结局有关。更好地了解这种情况以及分娩时相关的死亡率和发病率风险有助于减少不良后果。
■确定癫痫妇女中严重的孕产妇和围产期发病率和死亡率的风险。
■这项丹麦基于人群的前瞻性登记研究,芬兰,冰岛,挪威,瑞典发生在1996年1月1日至2017年12月31日之间。数据分析于2022年8月至2023年11月进行。参与者包括所有妊娠22周或更长时间的单胎分娩。排除出生体重或妊娠长度信息缺失或无效的出生。研究小组确定了4511267次分娩,其中4475984名是无癫痫妇女,35283名是癫痫母亲。
■产妇在分娩前记录癫痫诊断。产前暴露于抗癫痫药物(ASM),定义为从受孕到分娩的任何产妇处方,也被检查了。
■妊娠或产后42天内发生的复合重度孕产妇发病率和死亡率以及复合重度新生儿发病率(例如,新生儿惊厥)和围产期死亡率(即,死产和死亡)在生命的前28天。使用具有logit-link的多变量广义估计方程来获得调整后的优势比(aOR)和95%CIs。
■癫痫队列中女性分娩时的平均(SD)年龄为29.9(5.3)岁。与没有癫痫的妇女相比,患有癫痫的妇女的复合严重孕产妇发病率和死亡率也较高(每1000分娩36.9比25.4)。患有癫痫的妇女的死亡风险(每1000次分娩0.23例死亡)也明显高于没有癫痫的妇女(每1000次分娩0.05例死亡),aOR为3.86(95%CI,1.48-8.10)。特别是,产妇癫痫与严重先兆子痫的几率增加有关,栓塞,弥散性血管内凝血或休克,脑血管事件,和严重的心理健康状况。癫痫妇女的胎儿和婴儿死亡率上升(aOR,1.20;95%CI,1.05-1.38)和重度新生儿发病率(aOR,1.48;95%CI,1.40-1.56)。在仅限于癫痫女性的分析中,与未暴露的女性相比,暴露于ASM的女性患严重孕产妇发病率的几率更高(aOR,1.24;95%CI,1.10-1.48),其新生儿的死亡率和严重发病率增加(aOR,1.37;95%CI,1.23-1.52)。
这项跨国研究表明,患有癫痫的女性在严重的孕产妇和围产期结局中的风险要高得多,在怀孕和产后死亡的风险增加。产妇癫痫和产妇使用ASM与产妇发病率和围产期死亡率和发病率增加有关。
UNASSIGNED: Maternal epilepsy is associated with adverse pregnancy and neonatal outcomes. A better understanding of this condition and the associated risk of mortality and morbidity at the time of delivery could help reduce adverse outcomes.
UNASSIGNED: To determine the risk of severe maternal and perinatal morbidity and mortality among women with epilepsy.
UNASSIGNED: This prospective population-based register study in Denmark, Finland, Iceland, Norway, and Sweden took place between January 1, 1996, and December 31, 2017. Data analysis was performed from August 2022 to November 2023. Participants included all singleton births at 22 weeks\' gestation or longer. Births with missing or invalid information on birth weight or gestational length were excluded. The study team identified 4 511 267 deliveries, of which 4 475 984 were to women without epilepsy and 35 283 to mothers with epilepsy.
UNASSIGNED: Maternal epilepsy diagnosis recorded before childbirth. Prenatal exposure to antiseizure medication (ASM), defined as any maternal prescription fills from conception to childbirth, was also examined.
UNASSIGNED: Composite severe maternal morbidity and mortality occurring in pregnancy or within 42 days postpartum and composite severe neonatal morbidity (eg, neonatal convulsions) and perinatal mortality (ie, stillbirths and deaths) during the first 28 days of life. Multivariable generalized estimating equations with logit-link were used to obtain adjusted odds ratios (aORs) and 95% CIs.
UNASSIGNED: The mean (SD) age at delivery for women in the epilepsy cohort was 29.9 (5.3) years. The rate of composite severe maternal morbidity and mortality was also higher in women with epilepsy compared with those without epilepsy (36.9 vs 25.4 per 1000 deliveries). Women with epilepsy also had a significantly higher risk of death (0.23 deaths per 1000 deliveries) compared with women without epilepsy (0.05 deaths per 1000 deliveries) with an aOR of 3.86 (95% CI, 1.48-8.10). In particular, maternal epilepsy was associated with increased odds of severe preeclampsia, embolism, disseminated intravascular coagulation or shock, cerebrovascular events, and severe mental health conditions. Fetuses and infants of women with epilepsy were at elevated odds of mortality (aOR, 1.20; 95% CI, 1.05-1.38) and severe neonatal morbidity (aOR, 1.48; 95% CI, 1.40-1.56). In analyses restricted to women with epilepsy, women exposed to ASM compared with those unexposed had higher odds of severe maternal morbidity (aOR ,1.24; 95% CI, 1.10-1.48) and their neonates had an increased odd of mortality and severe morbidity (aOR, 1.37; 95% CI, 1.23-1.52).
UNASSIGNED: This multinational study shows that women with epilepsy were at considerably higher risk of severe maternal and perinatal outcomes and increased risk of death during pregnancy and postpartum. Maternal epilepsy and maternal use of ASM were associated with increased maternal morbidity and perinatal mortality and morbidity.