Self-Discontinuation of Antiseizure Medication During Pregnancy Increases Postpartum Seizure Frequency

Year 2022, Volume: 12 Issue: 3, 174 - 180, 31.12.2022

Miray Atacan Yaşgüçlükal , Zeynep Acar , Birgül Baştan , Aytül Mutlu , Özlem Çokar

https://doi.org/10.26650/experimed.1183414

Abstract

Objectives: The study aimed to investigate the rate of unplanned pregnancies, changes in seizure frequencies during the 6 months before the pregnancy, during the pregnancy, and the 6 months after the pregnancy, and antiseizure medication (ASM) compliances in women with epilepsy (WWEs).

Materials and Methods: The study retrospectively evaluated WWEs who were followed up in the epilepsy outpatient clinic of a training and research hospital between 1997-2021 and had used ASMs for at least 6 months prior to their pregnancy.

Results: The study assessed a total of 158 pregnancies for 77 WWEs, with 112 pregnancies resulting in live births, 71.4% of which were unplanned pregnancies. Unplanned pregnancies are more common in less educated women (p = 0.02). Of the women, 35 self-discontinued their ASMs during pregnancy, and these women were younger than the WWEs who continued taking their ASMs (p = 0.003). In addition, folic acid supplement use was lower in women who self-discontinued their ASMs (p = 0.031). The rate of increase in seizure frequency during postpartum period compared to pregnancy was higher in women who self -discontinued ASMs (p = 0.032).

Conclusion: Self–discontinuation of ASM during pregnancy is related to an increase in postpartum seizure frequency. WWEs should be given advice on how to minimize the risk of seizure during the postpartum period..

Keywords

epilepsy, seizures, postpartum period, pregnancy

References

• 1. Fairgrieve SD, Jackson M, Jonas P, Walshaw D, White K, Montgomery TL, et al. Population based, prospective study of the care of women with epilepsy in pregnancy. Br Med J 2000; 321(7262): 674-5. [CrossRef] google scholar
• 2. Olafsson E, Hallgrimsson JT, Hauser WA, Ludvigsson P, Gudmundsson G. Pregnancies of women with epilepsy: a population-based study in Iceland. Epilepsia 1998; 39(8): 887-92. [CrossRef] google scholar
• 3. Bollig KJ, Jackson DL. Seizures in pregnancy. Obstet Gynecol Clin North Am 2018; 45(2): 349-67. [CrossRef] google scholar
• 4. Veroniki AA, Cogo E, Rios P, Straus SE, Finkelstein Y, Kealey R, et al. Comparative safety of anti-epileptic drugs during pregnancy: A systematic review and network meta-analysis of congenital malformations and prenatal outcomes. BMC Med 2017; 15(1): 1-20. [CrossRef] google scholar
• 5. Kjaer D, Christensen J, Bech BH, Pedersen LH, Vestergaard M, Olsen J. Preschool behavioral problems in children prenatally exposed to antiepileptic drugs - a follow-up study. Epilepsy Behav 2013; 29(2): 407-11. [CrossRef] google scholar
• 6. Viale L, Allotey J, Cheong-see F, Arroyo-Manzano D, Mccorry D, Bagary M, et al. Epilepsy in pregnancy and reproductive outcomes : A systematic review and meta-analysis. Lancet 2015; 6736(15): 1-8. [CrossRef] google scholar
• 7. Vajda FJE, Hitchcock A, Graham J, O'Brien T, Lander C, Eadie M. Seizure control in antiepileptic drug-treated pregnancy. Epilepsia 2008; 49(1): 172-6. [CrossRef] google scholar
• 8. Vajda FJE, O'Brien TJ, Graham JE, Hitchcock AA, Lander CM, Eadie MJ. Predicting epileptic seizure control during pregnancy. Epilepsy Behav 2018; 78: 91-5. [CrossRef] google scholar
• 9. Nucera B, Brigo F, Trinka E, Kalss G. Treatment and care of women with epilepsy before, during, and after pregnancy: a practical guide. Ther Adv Neurol Disord 2022; 15: 17562864221101688. [CrossRef] google scholar
• 10. Wellings K, Jones KG, Mercer CH, Tanton C, Clifton S, Datta J, et al. The prevalence of unplanned pregnancy and associated factors in Britain: Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet 2013; 382(9907): 180716. [CrossRef] google scholar
• 11. Goto A, Yasumura S, Reich MR, Fukao A. Factors associated with unintended pregnancy in Yamagata, Japan. Soc Sci Med 2002; 54(7): 1065-79. [CrossRef] google scholar
• 12. Zhang Y yao, Song C geng, Wang X, Jiang Y li, Zhao J jing, Yuan F, et al. Clinical characteristics and fetal outcomes in women with epilepsy with planned and unplanned pregnancy: A retrospective study. Seizure 2020; 79: 97-102. [CrossRef] google scholar
• 13. Shahla M, Hijran B, Sharif M. The course of epilepsy and seizure control in pregnant women. Acta Neurol Belg 2018; 118(3): 45964. [CrossRef] google scholar
• 14. EUROCAT. EUROCAT Guide 1 . 4 and Reference Documents ((Last update version 28/12/2018). 2013; (2013). Available from: www. eurocat-network.eu/ google scholar
• 15. Johnson EL, Burke AE, Wang A, Pennell PB. Unintended pregnancy, prenatal care, newborn outcomes, and breastfeeding in women with epilepsy. Neurology 2018; 91(11): e1031 LP-e1039. [CrossRef] google scholar
• 16. Herzog AG, Mandle HB, Cahill KE, Fowler KM, Hauser WA. Predictors of unintended pregnancy in women with epilepsy. Neurology 2017; 88(8): 728-33. [CrossRef] google scholar
• 17. Bayrak M, Bozdag H, Karadag C, Gunay T, Goynumer G. Retrospective analysis of obstetric and perinatal outcomes in pregnant women with epilepsy. İstanbul Kanuni Sultan Süleyman Tıp Derg 2014; 6(3): 127-32. [CrossRef] google scholar
• 18. Ozdemir O, Sari ME, Kurt A, Sakar VS, Atalay CR. Pregnancy outcome of 149 pregnancies in women with epilepsy: Experience from a tertiary care hospital. Interv Med Appl Sci 2015; 7(3): 10813. [CrossRef] google scholar
• 19. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. 2018 Türkiye Nüfus ve Sağlık Araştırması. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, TC Cumhurbaşkanlığı Strat ve Bütçe Başkanlığı ve TÜBİTAK, Ankara, Türkiye. 2019; Available from: https:// hips.hacettepe.edu.tr/tr/2018_turkiye_nufus_ve_saglik_ arastirmasi-55 google scholar
• 20. Madazlı R, Öncül M, Albayrak M, Uludağ S, Eşkazan E, Ocak V. Gebelik ve epilepsi: 44 olgunun değerlendirilmesi. Cerrahpaşa Med J 2004; 35: 126-30. google scholar
• 21. Man SL, Petersen I, Thompson M, Nazareth I. Antiepileptic drugs during pregnancy in primary care: A UK Population based study. PLoS One 2012; 7(12). [CrossRef] google scholar
• 22. Sweileh WM, Ihbesheh MS, Jarar IS, Taha ASA, Sawalha AF, Zyoud SH, et al. Self-reported medication adherence and treatment satisfaction in patients with epilepsy. Epilepsy Behav 2011; 21(3): 301-5. [CrossRef] google scholar
• 23. Lupattelli A, Spigset O, Nordeng H. Adherence to medication for chronic disorders during pregnancy: Results from a multinational study. Int J Clin Pharm 2014; 36(1): 145-53. [CrossRef] google scholar
• 24. Vajda FJE, O'Brien TJ, Graham JE, Hitchcock AA, Perucca P, Lander CM, et al. Epileptic seizure control during and after pregnancy in Australian women. Acta Neurol Scand 2022; 145(6): 730-6. [CrossRef] google scholar
• 25. Crawford P. Best practice guidelines for the management of women with epilepsy. 2005; 46(3): 117-24. [CrossRef] google scholar
• 26. Pennell PB. Pregnancy in the woman with epilepsy: Maternal and fetal outcomes. Semin Neurol 2002; 22(3): 299-307. [CrossRef] google scholar
• 27. Walker SP, Permezel M, Berkovic SF. The management of epilepsy in pregnancy. BJOG An Int J Obstet Gynaecol 2009; 116(6): 758-67. [CrossRef] google scholar
• 28. Crawford P, Hudson S. Understanding the information needs of women with epilepsy at different lifestages: Results of the "Ideal World" survey. Seizure 2003; 12(7): 502-7. [CrossRef] google scholar