Seizure drugs tied to pregnancy risks

NEW YORK (Reuters Health) - New research on the links between seizure medication and pregnancy complications highlights the hard choices that pregnant women with epilepsy must make.

Scientists from the University of Bergen in Norway found that women with epilepsy are more likely to have pregnancy complications, and that the added risks were largely "associated with the use of anti-epileptic drugs in pregnancy."

Women who suffer from epilepsy, a brain disorder that involves periodic seizures, face especially difficult decisions about how to treat their condition while pregnant.

Previous research suggests that seizures during pregnancy can harm both mother and child. To prevent seizures, physicians often advise expectant mothers to continue taking their seizure medication.

To assess the range of risks to epileptic mothers and their babies, the authors compared medical records covering the pregnancies of nearly 200 women with epilepsy to those of the same number of women without epilepsy. They also looked at differences between the epileptic women who were taking seizure medications and those who were not.

Overall, epileptic women were more than twice as likely as women without epilepsy to experience preeclampsia -- and four times more likely to have a severe case.

Preeclampsia is characterized by high blood pressure and protein buildup in the urine, and severe preeclampsia is a serious condition that can lead to the death of both mother and child.

Women with epilepsy were also at higher risk for vaginal bleeding early in pregnancy (3.8 times more likely than non-epileptic women), of needing a Cesarean section or induced labor (1.8 times), of giving birth prematurely (nearly 6 times), and of having a baby with malformations (6.5 times the risk of women without epilepsy).

When the researchers analyzed pregnancy risks among just the women with epilepsy, those who were not taking seizure medications had similar risks for some complications -- bleeding and induced or cesarean birth -- as women without epilepsy.

Women taking seizure medications still had the raised risks for all complications.

Nearly 8 percent of women who took epilepsy medication suffered from severe preeclampsia, compared to just under 3 percent of women with epilepsy who did not take medication.

Women who took seizure drugs were also more than twice as likely to have labor induced and emergency Cesarean sections as epileptic women who did not take the medication.

The study does not prove that seizure medications caused the complications. Women who took medication could be different from the women who were not on medication in other ways, for instance.

These results don't mean women with epilepsy should stop taking their medications while pregnant, said the study's lead author, Dr. Ingrid Borthen. The apparent risks from taking epilepsy medication don't outweigh the known potential costs of suffering seizures during pregnancy, she told Reuters Health.

"The overall risk (of complications associated with medication) is low, and it is important to continue the medications during pregnancy to avoid seizures," Borthen said.

Dr. Autumn Klein, a neurologist at Brigham and Women's Hospital in Boston who was not involved in the study, agrees. "It's best to treat them with medications, because convulsions can be dangerous to the mom and the baby," Klein told Reuters Health.

Given the risks that women with epilepsy face during pregnancy, Klein believes that physicians "really need to pay close attention to these patients from an obstetric standpoint and an epilepsy standpoint. Problems come up when patients don't follow up with their physicians."

Klein advises that women with epilepsy visit their neurologists and obstetricians before and during pregnancy to minimize the risk of complications, and encourages specialists to cooperate and communicate in the care of these high-risk patients.

SOURCE: bit.ly/jwca8i, BJOG: An International Journal of Obstetrics and Gynaecology, July 2011.