First and second trimester laboratory changes and perinatal outcomes in pregnant women with epilepsy

Abstract

Aims: The aim of this study is to comprehensively evaluate the demographic, first-second trimester laboratory parameters and perinatal outcomes in pregnant women with epilepsy. Methods: The study had a total of 73 pregnant women with epilepsy, along with 149 healthy pregnant women. Demographic data, first-second trimester laboratory parameters, seizures during pregnancy, the administration of antiepileptic medicines and perinatal outcomes were documented from September 2022 to 2023. Pregnant women with epilepsy were formed into subgroups according to whether they had seizures during pregnancy or not and whether they used antiepileptic drugs, and first- and second-trimester laboratory parameters were compared between the groups. Furthermore, univariate and multivariate linear regression analysis investigated the relationship between these parameters with the composite adverse neonatal outcomes (CANO). Results: In the study, 72.7% of pregnant women diagnosed with epilepsy were receiving antiepileptic treatment (75.4% monotherapy and 24.6% polytherapy). The incidence of seizures during pregnancy was 38.3%. The epilepsy group exhibited statistically significant differences from the control group in the following areas: gestational age at delivery, preterm birth rate, cesarean section rate, birth weight, neonatal head circumference, APGAR score <7 at the 1st and 5th minutes, and CANO. The Neutrophil to Lymphocyte Ratio (NLR) was significantly higher in the epilepsy group in the second trimester (p=0.027), and the monocyte to lymphocyte ratio (MLR) was significantly higher in the first trimester in the epilepsy group (p<0.001). Upon comparing who experienced seizures during pregnancy and those who did not, no significant difference was found between the two groups. In the univariate logistic regression model, it was determined that having a seizure during pregnancy was a significant predictor, indicating a higher likelihood of developing perinatal complications. Multivariate linear regression analysis showed no significant correlation. Conclusion: The laboratory results of pregnant women with epilepsy during the first and second trimesters show differences compared to healthy pregnant women. Pregnant women diagnosed with epilepsy were associated with a higher risk of preterm delivery and giving birth to newborns with lower birth weight and head circumference. These differences may have significance in the follow-up and care of pregnant women with epilepsy.

Keywords

• Epilepsy
• perinatal outcomes
• first- and second-trimester laboratory parameters

Supporting Institution

None

Ethical Statement

ETHICAL DECLARATIONS Ethics Committee Approval: The study was initiated with the approval of the Ankara Etlik City Hospital Ethics Committee (Date: 2023, Decision No: AESH-EK1-2023-170). Informed Consent: Because the study was designed retrospectively, no written informed consent form was obtained from patients. Referee Evaluation Process: Externally peer-reviewed. Conflict of Interest Statement: The authors have no conflicts of interest to declare. Financial Disclosure: The authors declared that this study has received no financial support. Author Contributions: All of the authors declare that they have all participated in the design, execution, and analysis of the paper, and that they have approved the final version.

Thanks

The authors extend their sincere admiration and appreciation to Prof. Dr. Can Tekin Iskender, whose profound expertise and experience significantly advanced our scientific progress and passed away so early.

References

1. Thijs RD, Surges R, O’Brien TJ, Sander JW. Epilepsy in adults. Lancet. 2019;393(10172):689-701.
2. Miller WR, Von Gaudecker J, Tanner A, Buelow JM. Epilepsy self-management during a pandemic: experiences of people with epilepsy. Epilepsy Behavior. 2020;111:107238. doi:10.1016/j.yebeh. 2020.107238
3. Fiest KM, Sauro KM, Wiebe S, et al. Prevalence and incidence of epilepsy. Neurology. 2017;88(3):296-303. doi:10.1212/WNL. 0000000000003509
4. Tomson T, Battino D, Bromley R, et al. Management of epilepsy in pregnancy: a report from the International League Against Epilepsy Task Force on Women and Pregnancy. Epileptic Disorders. 2019;21(6):497-517. doi:10.1684/epd.2019.1105
5. 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. 2015;72(9):981. doi:10.1001/jamaneurol.2015.1017
6. Benini R, Roth R, Khoja Z, Avoli M, Wintermark P. Does angiogenesis play a role in the establishment of mesial temporal lobe epilepsy?. Int J Development Neurosci. 2016;49:31-36. doi:10. 1016/j.ijdevneu.2016.01.001
7. Leal B, Chaves J, Carvalho C, et al. Brain expression of inflammatory mediators in mesial temporal lobe epilepsy patients. J Neuroimmunol. 2017;313:82-88.
8. Rana A, Musto AE. The role of inflammation in the development of epilepsy. J Neuroinflammation. 2018;15(1):144. doi:10.1186/s12974-018-1192-7

9. Hosseini S, Mofrad AME, Mokarian P, et al. Neutrophil to lymphocyte ratio in epilepsy: a systematic review. Mediators Inflammation. 2022;2022(1):4973996. doi:10.1155/2022/4973996
10. Besimoglu B, Öcal FD, Sinaci S, Atalay A, Tanaçan A, Şahin D. Effect of antiepileptic drugs on serum biochemical marker levels of first and second trimester screening tests. J Obstet Gynaecol Res. 2022;48(7):1607-1612. doi:10.1111/jog.15250
11. Tuğrul Ersak D, Üçyıldız Ö, Yıldırım M, et al. Role of platelet indices in pregnant women with epilepsy. Arch Epilepsy. 2023; 29:3. doi:10.4274/ArchEpilepsy.2023.23080
12. Laleli Koç B, Ersak DT, Üçyıldız Ö, et al. Changes in the maternal serum inflammatory parameters of pregnant women with epilepsy. Arch Epilepsy. 2023;29(3). doi:10.4274/ArchEpilepsy. 2023.23100
13. Çendek BD, Bayraktar B, Körpe B, Ustun Y, Keskin HL, Erel Ö. Ischemia-modified albumin levels in threatened abortion and missed abortion compared to healthy pregnancies. J Exp Clin Med. 2024;41(1):102-107.
14. Christoforaki V, Zafeiriou Z, Daskalakis G, Katasos T, Siristatidis C. First trimester neutrophil to lymphocyte ratio (NLR) and pregnancy outcome. J Obstetr Gynaecol. 2020;40(1):59-64. doi:10.1080/01443615.2019.1606171
15. Hai L, Hu ZD. The clinical utility of neutrophil to lymphocyte ratio in pregnancy related complications: a mini-review. J Lab Precision Med. 2020;5(0). doi:10.21037/jlpm.2019.10.03
16. Shi X, Zhang X, Song S, et al. Correlation between inflammatory markers over time and disease severity in status epilepticus: a preliminary study. Front Neurol. 2024;15:1334415. doi:10.3389/fneur.2024.1334415
17. Viale L, Allotey J, Cheong-See F, et al. Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet. 2015;386(10006):1845-1852. doi:10.1016/S0140-6736(15) 00045-8
18. Hvas CL, Henriksen TB, Østergaard JR, Dam M. Epilepsy and pregnancy: effect of antiepileptic drugs and lifestyle on birthweight. Int J Obstetr Gynaecol. 2000;107(7):896-902. doi:10.1111/j.1471-0528.2000.tb11089.x
19. Hiilesmaa VK, Teramo K, Granström ML, Bardy AH. Fetal head growth retardation associated with maternal antiepileptic drugs. Lancet. 1981;318(8239):165-167. doi:10.1016/S0140-6736 (81)90354-8
20. Almgren M, Källén B, Lavebratt C. Population-based study of antiepileptic drug exposure in utero-influence on head circumference in newborns. Seizure. 2009;18(10):672-675. doi: 10.1016/j.seizure.2009.09.002
21. Van Marter LJ, Pennell PB, Brown C, et al. Neonatal outcomes in the MONEAD study of pregnant women with epilepsy. J Pediatr X. 2021;7:100073. doi:10.1016/j.ympdx.2021.100073
22. Borgelt L, Hart F, Bainbridge J. Epilepsy during pregnancy: focus on management strategies. IJWH. 2016;8:505-517. doi:10.2147/IJWH.S98973