Posts Tagged WWE
[Abstract] The use of antidepressant drugs in pregnant women with epilepsy: A study from the Australian Pregnancy Register
To study interactions between first‐trimester exposure to antidepressant drugs (ADDs) and antiepileptic drugs (AEDs), and a history of clinical depression and/or anxiety, on pregnancy outcomes and seizure control in pregnant women with epilepsy (WWE).
We examined data from the Australian Pregnancy Register of Antiepileptic Drugs in Pregnancy, collected from 1999 to 2016. The register is an observational, prospective database, from which this study retrospectively analyzed a cohort. Among the AED‐exposed outcomes, comparisons were made among 3 exposure groups: (1) pregnancy outcomes with first‐trimester exposure to ADDs; (2) outcomes with mothers diagnosed with depression and/or anxiety but who were not medicated with an ADD; and (3) those with mothers who were not diagnosed with depression and/or anxiety and were not medicating with ADD. Prevalence data was analyzed using Fisher’s exact test.
A total of 2124 pregnancy outcomes were included in the analysis; 1954 outcomes were exposed to AEDs in utero, whereas 170 were unexposed. Within the group of WWE taking AEDs, there was no significant difference in the prevalence of malformations in infants who were additionally exposed to ADDs (10.2%, 95% confidence interval [CI] 3.9‐16.6), compared to individuals in the non–ADD‐medicated depression and/or anxiety group (7.7%, 95% CI 1.2‐14.2), or those without depression or anxiety (6.9%, 95% CI 5.7‐8.1; P = 0.45). The malformation rates in pregnancy outcomes unexposed to AEDs were also similar in the above groups (P = 0.27). In WWE medicated with AEDs and ADDs, the frequency of convulsive seizures (P = 0.78), or nonconvulsive seizures (P = 0.45) throughout pregnancy, did not differ across comparative groups.
Co‐medicating with ADDs in WWE taking AEDs does not appear to confer a significant added teratogenic risk, and it does not affect seizure control.
Question Do women with epilepsy without a prior diagnosis of infertility or related disorders have the same likelihood of achieving pregnancy as their peers without epilepsy?
Findings This multicenter cohort study of 89 women with epilepsy and 108 control women found no difference in the proportion of women who achieved pregnancy less than 12 months after enrollment in the study. Among women with epilepsy, 54 (60.7%) achieved pregnancy vs 65 (60.2%) among control women.
Meaning Women with epilepsy without a history of infertility or related disorders seeking pregnancy had similar likelihood of achieving pregnancy compared with their peers without epilepsy.
Importance Prior studies report lower birth rates for women with epilepsy (WWE) but have been unable to differentiate between biological and social contributions. To our knowledge, we do not have data to inform WWE seeking pregnancy if their likelihood of achieving pregnancy is biologically reduced compared with their peers.
Objective To determine if WWE without a prior diagnosis of infertility or related disorders are as likely to achieve pregnancy within 12 months as their peers without epilepsy.
Design, Setting, and Participants The Women With Epilepsy: Pregnancy Outcomes and Deliveries study is an observational cohort study comparing fertility in WWE with fertility in control women (CW) without epilepsy. Participants were enrolled at 4 academic medical centers and observed up to 21 months from November 2010 to May 2015. Women seeking pregnancy aged 18 to 40 years were enrolled within 6 months of discontinuing contraception. Exclusion criteria included tobacco use and a prior diagnosis of infertility or disorders that lower fertility. Eighteen WWE and 47 CW declined the study, and 40 WWE and 170 CW did not meet study criteria. The Women With Epilepsy: Pregnancy Outcomes and Deliveries electronic diary app was used to capture data on medications, seizures, sexual activity, and menses. Data were analyzed from November 2015 to June 2017.
Main Outcomes and Measures The primary outcome was proportion of women who achieved pregnancy within 12 months after enrollment. Secondary outcomes were time to pregnancy using a proportional hazard model, pregnancy outcomes, sexual activity, ovulatory rates, and analysis of epilepsy factors in WWE. All outcomes were planned prior to data collection except for time to pregnancy.
Results Of the 197 women included in the study, 142 (72.1%) were white, and the mean (SD) age was 31.9 (3.5) years among the 89 WWE and 31.1 (4.2) among the 108 CW. Among 89 WWE, 54 (60.7%) achieved pregnancy vs 65 (60.2%) among 108 CW. Median time to pregnancy was no different between the groups after controlling for key covariates (WWE: median, 6.0 months; 95% CI, 3.8-10.1; CW: median, 9.0 months; 95% CI, 6.5-11.2; P = .30). Sexual activity and ovulatory rates were similar in WWE and CW. Forty-four of 54 pregnancies (81.5%) in WWE and 53 of 65 pregnancies (81.5%) in CW resulted in live births. No epilepsy factors were significant.
Conclusions and Relevance Women with epilepsy seeking pregnancy without prior known infertility or related disorders have similar likelihood of achieving pregnancy, time to pregnancy, and live birth rates compared with their peers without epilepsy.
Approximately 12.5 million women of childbearing age worldwide have epilepsy.1 Most studies suggest birth rates in women with epilepsy (WWE) to be 37% to 88% of other groups.2,3 Conversely, the Northern Finland Birth Cohort4 reported the number of children born to WWE did not differ from the reference group overall, although epilepsy not in remission was associated with fewer children. None of these studies collected information about the desire or attempts to achieve pregnancy. Birth rates could be lower in WWE because of social factors (eg, lower marriage rates or lower rates of seeking pregnancy) and/or biological factors (eg, decreased ovulatory rates). A UK survey5 reported 33% of WWE respondents were not considering having children because of their epilepsy. Neurologists do not have the information needed to counsel their female patients who desire pregnancy whether they are as likely to achieve pregnancy and to have a live birth as their peers.
We designed this study to determine whether WWE without a preexisting diagnosis of infertility or associated disorders who are following their clinically determined treatment regimen differ from women without epilepsy when attempting to achieve pregnancy. The primary aim was the proportion of women achieving pregnancy within 1 year. Secondary aims were comparisons between WWE and women without epilepsy for (1) live birth rates, (2) time to achieve pregnancy, (3) sexual activity rates, and (4) ovulatory rates. An additional secondary aim was to explore seizure and medication factors within WWE that could affect fertility.
To our knowledge, no prior studies prospectively compared WWE with women without epilepsy attempting to conceive. Our study approach excluded women with known infertility diagnosis or diagnoses associated with reproductive disorders (eg, polycystic ovary syndrome [PCOS]). This study specifically addressed the woman who arrives in clinic with no reason to suspect infertility other than an epilepsy diagnosis.[…]