目的:本研究旨在探讨妊娠期不同抗癫痫药物(ASM)使用模式与不良产科结局(早产,低出生体重[LBW],并且小于胎龄[SGA])。
方法:这项回顾性队列研究使用台湾的出生证明申请和国民健康保险数据(2004年1月1日至2018年12月31日)。我们每周在孕前慢性用户的癫痫孕妇中检索ASM,并使用基于组的轨迹模型来识别不同的使用模式。采用Logistic回归检验ASM使用模式与早产风险之间的关系。LBW,SGA。此外,作为一项探索性研究,我们揭示了这些孕前慢性使用者的产后ASM利用模式。
结果:在2175名患有癫痫的孕妇中,我们确定了怀孕期间使用ASM的四种模式:频繁和连续(64.87%),频繁但不连续(7.08%),间歇性(19.72%),以及间歇性和不连续用户(8.32%)。与频繁和连续的用户相比,早产频繁但不连续的调整后优势比,间歇性,间歇性和不连续用户为.83(95%置信区间[CI]=.47-1.48),.71(95%CI=.47-1.05),和0.88(95%CI=0.52-1.49),分别。对于LBW和SGA观察到类似的结果。在探索性研究中,我们发现,我们的大多数研究对象在分娩前后保持相同的模式。
结论:在考虑了暴露的持续时间和时间后,我们的研究未发现4种不同的ASM使用模式与癫痫女性产科不良结局之间存在关联.研究结果表明,在评估风险和收益后,癫痫孕妇可以获得最佳的癫痫发作控制。
OBJECTIVE: This study was undertaken to examine the association between different patterns of antiseizure medication (ASM) use during pregnancy and adverse obstetric outcomes (preterm birth, low birth weight [LBW], and small for gestational age [SGA]).
METHODS: This retrospective cohort study used the Birth Certificate Application and National Health Insurance data in Taiwan (January 1, 2004 through December 31, 2018). We retrieved weekly ASM among pregnant women with epilepsy who were prepregnancy chronic users and used group-based trajectory modeling to identify distinct patterns of use. Logistic regressions were adopted to examine the association between patterns of ASM use and risk of preterm birth, LBW, and SGA. In addition, we revealed postnatal ASM utilization pattern among these prepregnancy chronic users as an exploratory study.
RESULTS: Of 2175 pregnant women with epilepsy, we identified four patterns of ASM use during pregnancy: frequent and continuous (64.87%), frequent but discontinuous (7.08%), intermittent (19.72%), and intermittent and discontinuous users (8.32%). Compared to frequent and continuous users, the adjusted odds ratios for preterm birth in frequent but discontinuous, intermittent, and intermittent and discontinuous users were .83 (95% confidence interval [CI] = .47-1.48), .71 (95% CI = .47-1.05), and .88 (95% CI = .52-1.49), respectively. Similar results were observed for LBW and SGA. In the exploratory study, we found that most of our study subjects maintained the same patterns before and after delivery.
CONCLUSIONS: After considering duration and timing of exposure, our study did not find an association between four distinct patterns of ASM use and adverse obstetric outcomes among women with epilepsy. The findings suggested that optimal seizure control could be received for pregnant women with epilepsy after evaluating the risks and benefits.