A Study of Pregnancy in Women with Epilepsy

Samantha, S (2009) A Study of Pregnancy in Women with Epilepsy. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION: Epilepsy is recognized as the commonest serious neurological disorder in the world. Women with epilepsy (WWE) experience several gender-related physical and social problems. They constitute high obstetric risk because of reduced fertility, risk of seizures during pregnancy, and complications of pregnancy. Hormonal and other factors can alter the pharmacokinetics of antiepileptic drugs (AED) during pregnancy and puerperium. Antenatal exposure to AEDs, particularly at higher dosage and in polytherapy, increases the risk of fetal malformation. Recent reports raise the possibility of selective developmental language deficits and neurocognitive deficits with antenatal exposure to AEDs. Epilepsy and antiepileptic therapy therefore affects both maternal and fetal well being. Seizure type as well as AEDs used have an effect on the course and outcome of pregnancy. Conversely, pregnancy affects seizure control and the pharmacokinetics of AEDs. The management of a woman with epilepsy during her pregnancy thus presents a major therapeutic challenge to the treating physician. AIMS OF THE STUDY: This study analyzes the incidence of various maternal & foetal outcomes occurring in pregnant women with epilepsy. Maternal outcomes: 1. Primary outcomes : abortions, IUD, live births, maternal mortality. 2. Secondary outcomes : Mode of delivery. Seizures during pregnancy and delivery. Foetal outcomes: 1. Primary outcome : Congenital malformations. 2. Secondary outcomes : Infant mortality, growth retardation. MATERIALS AND METHODS: Criteria for patient selection: • This study includes women with epilepsy already registered at the epilepsy clinic of the Government Stanley hospital, Chennai. • Patients were included in the study when pregnancy was first reported. Exclusion criteria: • Patients changing antiepileptic drugs during the course of the study were excluded. Methodology: This is an observational study involving women with epilepsy undergoing regular treatment at the epilepsy clinic of the department of neurology of the Government Stanley hospital. It addresses various issues faced by epileptic women during and after pregnancy. • Pregnant women with epilepsy are included in the study when pregnancy is first reported. • Data regarding seizure type, antiepileptic drug used, seizure frequency, folate supplementation is collected using a proforma based on the EURAP pregnancy registry proforma during the first visit. The patient is also counseled about various aspects of pregnancy in epileptics. • Patient is followed up through monthly visits to the epilepsy clinic. Biochemical screening in the form of serum alpha feto protein level is done by the 12-14th week of gestation. Ultrasound scan for foetal anomalies is done during the 16-18th week of pregnancy. • After delivery data is collected regarding outcome, intrapartum seizures, mode of delivery using a proforma. The baby is examined for growth retardation as well as congenital malformations. OBSERVATIONS AND ANALYSIS: This study was conducted in Government Stanley hospital during the years 2007-2008. A total of 93 women with epilepsy were enrolled and followed up. All patients were already on treatment at the epilepsy clinic at the time of inclusion into the study. Patients who changed anti epileptic drugs during the course of pregnancy were excluded from the study. CONCLUSION: In a study of 93 pregnancies in women with epilepsy it was found that: 1. A majority of 79.8% were seizure free. 20% had seizures in first trimester and this figure diminished to 13.9% later in the course of pregnancy. 2. Intrapartum seizures were seen to be related to: a. Seizures in the third trimester. b. Generalized type of seizure disorder. c. Increased incidence of operative delivery. 3. An increased incidence of spontaneous abortions was seen in women with epilepsy. This was found to correlate with seizures in the first trimester and also with a lack of folic acid supplementation. 4. There was an increased incidence of operative deliveries in women with epilepsy. This was associated with polytherapy especially including sodium valproate. 5. Only 62% of patients received folic acid supplementation. Incidence of complications like spontaneous abortions were higher in patients not receiving folic acid. 6. Low birth weight is the commonest adverse neonatal outcome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Pregnancy ; Women ; Epilepsy.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 16:48
Last Modified: 23 Mar 2018 16:48
URI: http://repository-tnmgrmu.ac.in/id/eprint/6511

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