Dados do Trabalho

Título

Obstetric and neonatal outcomes, seizures profile and epileptic drugs in pregnant women in Alagoas-Brasil

Introdução

European studies indicate that epilepsy affects about 0.4 to 0.8% of pregnant women, and most of them need to use antiepileptic drugs continuously.

Objetivo

Objectives: To describe the most frequent obstetric and neonatal outcomes, seizures and antiepileptic drugs in pregnant women with epilepsy (PWWE).

Método

Methods: This cohort study was based on medical records of PWWE in Brazilian high-risk maternity hospitals from 2008 to 2020. The inclusion criteria used were: PWWE and pregnant women no epilepsy (PWNE), with controlled seizures or refractory epilepsy, aged less than 40 years.

Resultados

The obsterics and neonatal outcomes found in PWWE was: Hypertension Gestacional Disease DHEG (OR=6.11; 95 % CI=3.39-11.00); Vaginal hemorrhage (OR=2.54; 95% CI=1.15-5.59); Preeclampsia (OR=8.04; 95% CI=2, 22-29.10); Polyhydramnios (OR=7.55; 95% CI=1.55-36.65); Miscarriage (OR=1.75; 95% CI=1.16-2.63); Stillbirth (OR=8.04; 95% CI=2.22-29.10), and those with generalized tonic–clonic seizures (GTCS) were more likely to have DHEG (OR=7.46; 95% CI=3.21-17, 33); and those who had GTCS and status epilepticus had higher chances of being hospitalized in a maternal ICU (OR=26.87; 95% CI=3.34-215.79); (OR=44.54; 95% CI=5.67-349.74) respectively, and using Phenytoin and Lamotrigine (OR=17.75; 95% CI=1.95-160.77) (OR=7, 10; 95% CI =1.03-48.64) respectively. While PWWE with status epilepticus were more likely to have preterm labor (OR=2.25; 95% CI=1.05-4.69). Status epilepticus had a lower chance of using phenobarbital (OR=0.17; 95% CI =0.07-0.45), being the same, together with Diazepam, the most used drugs in PWWE with GTCS and status epilepticus (OR=10.31; 95% CI =1.17-9.7); OR=31.37; 95% CI =3.90-252.06), respectively. When we studied the AEDs most used by PWWE observed that only 15% of pregnant women did not use AEDs, 55.6% used monotherapy and 29.4% polytherapy, with Phenobarbital being the most used AED with 31.6%, followed by Carbamazepine with 15%.

Conclusão

Conclusions: The study observed relevant adverse obstetric and neonatal outcomes in PWWE. A large number of PWWE used AEDs, observed an association with adverse outcomes and severe seizures, however we did not find an association with congenital malformation. Therefore, further studies are needed to infer the cause of the outcomes from exposure to the disease or from the use of AEDs.

Palavras-chave

KEYWORDS: Epilepsy in pregnancy, Epileptic seizure, Tonic clonic seizure, Status epilepticus, Antiepileptic drug.