Epilepsy and pregnancy: risk factors for obstetric and perinatal complications

Objective. To determine baseline factors associated with active epilepsy during pregnancy; to evaluate the relationship between mono- and polytherapy and individual obstetric and perinatal complications. Materials and methods. A prospective examination and delivery of 382 pregnant women with epilepsy were conducted. The women were divided into three groups: Group 1 (n=178) included pregnant women with active epileptic seizures; Group 2 (n=120) included pregnant women in drug-induced remission; and Group 3 (n=84) included patients in long-term remission (10 years or more) without taking antiepileptic drugs (AEDs). Anamnestic data, treatment adherence (Morisky—Green scale), trimester-specific changes in antiepileptic therapy and AED dosages, the course of epilepsy, and obstetric and perinatal complications were assessed. Neonatal weight and height were assessed using INTERGROWTH-21 standards. Results. Absolute adherence to therapy was recorded in 47.8% of patients with active epilepsy, in 80.0% of patients with drug-induced remission, and in 89.3% of patients with epilepsy in the resolved stage (p<0.001). Seizures during the year before pregnancy were noted in 86.0, 15.8, and 0% of patients, respectively; frequent seizures were observed only in the active epilepsy group. Among women with available therapy data, the frequency of polytherapy was higher in the active epilepsy group at all stages of observation; in the third trimester, it was 42.2% versus 3.5% in the drug-induced remission group (p<0.001). Polytherapy, compared with monotherapy, was associated with a higher rate of cesarean section (28.2% vs. 14.8%; p=0.019) and chronic fetal hypoxia (25.3% vs. 12.5%; p=0.016). Conclusion. Polytherapy was associated with abdominal delivery and chronic fetal hypoxia in univariate analysis; its independent contribution cannot be established without accounting for the severity and type of epilepsy, seizure frequency, use of specific medications, and other factors. These results support the need to optimize preconception therapy, improve adherence to AEDs, and individually monitor them during pregnancy.