GEBELİKTE EPİLEPSİ VE ANTİEPİLEPTİK TEDAVİNİN ANNE VE YENİDOĞAN ÜZERİNE ETKİSİ

Yıl 2023, Cilt: 20 Sayı: 1, 1603 - 1611, 30.03.2023

Dilay Karademir , Mustafa Karademir , İrem Küçükyıldız , Nazan Yurtçu , İlkin Seda Can , Esra Gültürk

https://doi.org/10.38136/jgon.1005697

Öz

Amaç: Bu çalışmada amaç epilepsi tanısı almış ve antiepileptik ilaç kullanan gebelerde epilepsi hastalığının ve uygulanan antiepileptik tedavi protokolünün, anne, fetüs ve yenidoğan üzerine etkisinin değerlendirilmesidir.
Gereç ve Yöntemler: Sivas Cumhuriyet Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği’nde 2015- 2020 tarihleri arasında gebelik takipleri yapılan ve epilepsi tanısı alan 55 gebe çalışmaya dahil edildi. Gebelerin yaşı, gebelik sayısı, doğum sayısı, epilepsi tanı yaşı, beden kitle indeksi (BKİ) , gebelikte sigara kullanımı, gebelik öncesi nöroloji kontrolüne gidip gitmedikleri, gebelik boyunca görülen nöbetlerin türü, hangi trimesterde nöbet geçirildiği ve sıklığı, gebelik sürecinde kullandıkları AEİ’lar ve tedavi protokolleri, gebelikte folik asit kullanımı değerlendirildi. Çalışmaya alınan gebelerde takipleri sırasında ortaya çıkan obstetrik komplikasyonlar ve doğum haftaları kaydedildi. Yenidoğan 1.-5. dk. Apgar skorları, fetal malformasyonlar ve fetal distres gibi erken neonatal sorunlar değerlendirildi.
Bulgular: Yaşların ortanca değeri 26 (17-42) olarak bulunmuştur. Gebelik sayısının ortancası 2 (1-8)’dir. Doğum sayısının ortancası 1 (0-6)’dır. Çalışmaya alınan kadınların epilepsi tanı yaşlarının ortalaması ise 15 (3-29)’tir. Hastaların 34 (%61,9)’ü generalize, 2 (%3,6)’si parsiyel nöbet geçirmiştir. 19 (%34,5)’u ise gebelik sürecinde nöbet geçirmemiştir. Gebelik takibi boyunca komplikasyon gelişenlerin ortalaması % 43,6, gelişmeyenlerin ortalaması % 56,4 bulunmuştur. Hamilelikte trimesterlerde geçirilen nöbet sayısı ile 1. dakika Apgar skoru arasında istatistiksel farklılık vardır (p<0,05). Hamilelikte kadınların nöbet geçirme sıklığı ile bebeklerde 1. dakika Apgar değeri arasında ters yönde zayıf anlamlı düzeyde ilişki saptanmıştır (r=-0,351; p=0,009) (Spearman Correlation test; α=0,01).
Sonuç: Bu olguların takibi deneyimli obstetrisyen ve epileptolog tarafından yapılmalıdır. Mümkünse epilepsi tedavisinde monoterapi uygulanmalı ve prekonsepsiyonel danışmanlık verilmelidir.

Anahtar Kelimeler

Epilepsi, gebelik, monoterapi, yenidoğan

THE IMPACT OF EPILEPSY AND ANTIEPLEPTIC THERAPY IN PREGNANCY ON MOTHER AND NEWBORN

Öz

Aim: The aim of this study was to evaluate the effect of epilepsy disease and the antiepileptic treatment protocol on the mother, fetus, and newborn in pregnant women, diagnosed with epilepsy and taking antiepileptic drugs.
Materials and Method: 55 pregnant women who were followed up at Sivas Cumhuriyet University Faculty of Medicine, Department of Obstetrics and Gynecology between 2015 and 2020 and diagnosed with epilepsy were included in the study. Age of pregnant women, number of pregnancies, number of births, age at diagnosis of epilepsy, body mass index (BMI), smoking during pregnancy, whether they went to neurology control before pregnancy, type of seizures during pregnancy, seizures in which trimester, and frequency, AED’s used during pregnancy and treatment protocols, folic acid use in pregnancy were evaluated. Obstetric complications that occurred during the follow-up of the pregnant women included in the study and the weeks of delivery were recorded. Newborn 1.-5. min. Early neonatal problems such as Apgar scores, fetal malformations and fetal distress were evaluated.
Results: The median age was found to be 26 (17-42). The median number of pregnancies is 2 (1-8). The median of the number of births is 1 (0-6). The average age of epilepsy diagnosis of the women included in the study was 15 (3-29). Thirty-four (61.9%) of the patients had generalized and 2 (3.6%) partial seizures. 19 (34.5%) of them did not have seizures during pregnancy. The average of those who developed complications during pregnancy follow-up was 43.6%, and the average of those who did not develop was 56.4%. There is a statistical difference between the number of seizures in trimesters of pregnancy and the 1st minute Apgar score (p<0.05). A weakly significant inverse correlation was found between the frequency of seizures in women during pregnancy and the 1st minute Apgar value in infants (r=-0.351; p=0.009) (Spearman Correlation test; α=0.01).
Conclusion: These cases should be followed up by an experienced obstetrician and epileptologist. If possible, monotherapy should be applied in the treatment of epilepsy, and preconceptional counseling should be given.

Anahtar Kelimeler

Pregnancy, epilepsy, monotherapy, newborn

Kaynakça

• 1. Siddiqi M, Zaman Q, Mehboob N, Mansoor S. A Registry of Maternal and Fetal Outcomes in Pregnant Epileptic Women from Pakistan. J Neurol Neurosci. 2019;10(04):1–6.
• 2. Gebelik E. Epilepside Gebelik, Doğum ve Doğum Sonu Sürecin Yönetimi ve Bakımı. 2018;49(1):117–25.
• 3. Tomson T, Battino D, Bromley R, Kochen S, Meador KJ, Pennell PB, et al. Global Survey of Guidelines for the Management of Epilepsy in Pregnancy: A report from the International League Against Epilepsy Task Force on Women and Pregnancy. Epilepsia Open. 2020;5(3):366–70.
• 4. Kusznir Vitturi B, Barreto Cabral F, Mella Cukiert C. Outcomes of pregnant women with refractory epilepsy. Seizure [Internet]. 2019;69(May):251–7. Available from: https://doi.org/10.1016/j.seizure.2019.05.009
• 5. Chawla L. Maternal and Fetal Outcomes of Women with Epilepsy: Study from a Tertiary Care Center in India. Obstet Gynecol Int J. 2015;3(1):223–7.
• 6. Hernández-Díaz S, McElrath TF, Pennell PB, Hauser WA, Yerby M, Holmes LB. Fetal growth and premature delivery in pregnant women on antiepileptic drugs. Ann Neurol. 2017;82(3):457–65.
• 7. Melikova S, Bagirova H, Magalov S. The impact of maternal epilepsy on delivery and neonatal outcomes. Child’s Nerv Syst. 2020;36(4):775–82.
• 8. Laganà AS, Triolo O, D’Amico V, Cartella SM, Sofo V, Salmeri FM, et al. Management of women with epilepsy: from preconception to post-partum. Arch Gynecol Obstet. 2016;293(3):493–503.
• 9. Tomson T, Battino D, Bromley R, Kochen S, Meador K, Pennell P, et al. Executive Summary: Management of epilepsy in pregnancy: A report from the International League Against Epilepsy Task Force on Women and Pregnancy. Epilepsia. 2019;60(12):2343–5.
• 10. Crawford P. CPD - Education and self-assessment epilepsy and pregnancy. Seizure. 2001;10(3):212–9.
• 11. RCOG. Epilepsy in Pregnancy (GTG No.68). 2016;(68). Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg68_epilepsy.pdf
• 12. Özdemir S, Balc O, Tazegül A, Said M, Demir A, Yüksekkaya HA. Assessment of Maternal and Perinatal Outcomes in Pregnancies Complicated by Epilepsy. 2010;(April):8–13.
• 13. MacDonald SC, Bateman BT, McElrath TF, Hernández-Díaz S. Mortality and Morbidity During Delivery Hospitalization Among Pregnant Women With Epilepsy in the United States. JAMA Neurol [Internet]. 2015 Sep;72(9):981–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26147878
• 14. Enquiries C. Saving Mothers’ Lives. 2011;118(March):2006–8.
• 15. Kazandi M, Ulusoy D, Mermer TK, Mete TL. Epilepsi Tanısı Almış Kadınlarda Gebelik Sonuçlarının Retrospektif Analizi Mert. 2009;(0542).
• 16. Çilliler AE. Epilepsy and Pregnancy: A retrospective analysis of 101 pregnancies. J Turkish Epilepsi Soc. 2018;25(2):69–75.
• 17. Battino D, Tomson T, Bonizzoni E, Craig J, Lindhout D, Sabers A, et al. Seizure control and treatment changes in pregnancy: Observations from the EURAP epilepsy pregnancy registry. Epilepsia. 2013;54(9):1621–7.
• 18. Watila MM, Beida O, Kwari S, Nyandaiti NW, Nyandaiti YW. Seizure occurrence, pregnancy outcome among women with active convulsive epilepsy: One year prospective study. Seizure [Internet]. 2015;26:7–11. Available from: http://dx.doi.org/10.1016/j.seizure.2015.01.007
• 19. Pennell PB. Pregnancy , Epilepsy , and Women ’ s Issues. :697–714.
• 20. Steegers-Theunissen RPM, Renier WO, Borm GF, Thomas CMG, Merkus HMWM, de Coul DAWO, et al. Factors influencing the risk of abnormal pregnancy outcome in epileptic women: A multi-centre prospective study. Epilepsy Res. 1994;18(3):261–9.
• 21. Goodlin RC, Heidrick WP. Fetal malformations associated with maternal hypoxia Schmidt ’ s syndrome presenting with intrauterine growth retardation and postpartum addisonian crisis. 1984;228–9.
• 22. Kahvecioğlu D, Tatar Aksoy H, Keskin Güler S, Yılmaz A, Çalışkan Ş, Alioğlu B. Neonatal Outcomes of Epileptic Mothers’ Infants in the Tertiary Level Of Neonatal Intensive Care Unit: Results from Single Center. İstanbul Kanuni Sultan Süleyman Tıp Derg. 2018;10(2):75–80.
• 23. Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol [Internet]. 2020;222(5):415–26. Available from: https://doi.org/10.1016/j.ajog.2020.02.017
• 24. 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.
• 25. Borthen I, ErikGilhus N. Pregnancy complications in patients with epilepsy. Curr Opin Obstet Gynecol. 2012;24(2):78–83.
• 26. Artama M, Gissler M, Malm H, Ritvanen A. Effects of maternal epilepsy and antiepileptic drug use during pregnancy on perinatal health in offspring: Nationwide, retrospective cohort study in Finland. Drug Saf. 2013;36(5):359–69.
• 27. Morrow J, Russell A, Guthrie E, Parsons L, Robertson I, Waddell R, et al. Malformation risks of antiepileptic drugs in pregnancy: A prospective study from the UK Epilepsy and Pregnancy Register. J Neurol Neurosurg Psychiatry. 2006;77(2):193–8.
• 28. Veiby G, Daltveit AK, Engelsen BA, Gilhus NE. Fetal growth restriction and birth defects with newer and older antiepileptic drugs during pregnancy. J Neurol. 2014;261(3):579–88.
• 29. Veiby G, Daltveit AK, Engelsen BA, Gilhus NE. Pregnancy, delivery, and outcome for the child in maternal epilepsy. Epilepsia. 2009;50(9):2130–9.