Maternal complications in pregnancy and childbirth for women with epilepsy: Time trends in a nationwide cohort


Autoři: Kim Christian Danielsson aff001;  Nils Erik Gilhus aff002;  Ingrid Borthen aff002;  Rolv Terje Lie aff004;  Nils-Halvdan Morken aff001
Působiště autorů: Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway aff001;  Department of Clinical Medicine, University of Bergen, Bergen, Norway aff002;  Department of Neurology, Haukeland University Hospital, Bergen, Norway aff003;  Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway aff004;  Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway aff005;  Department of Clinical Science, University of Bergen, Bergen, Norway aff006
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225334

Souhrn

Objective

Obstetric trends show changes in complication rates and maternal characteristics such as caesarean section, induced labour, and maternal age. To what degree such general time trends and changing patterns of antiepileptic drug use influence pregnancies of women with epilepsy (WWE) is unknown. Our aim was to describe changes in maternal characteristics and obstetric complications in WWE over time, and to assess changes in complication risks in WWE relative to women without epilepsy.

Methods

This was a nationwide cohort study of all first births in the Medical Birth Registry of Norway, 1999–2016. We estimated maternal characteristics, complication rates, and risks for WWE compared to women without epilepsy. Main maternal outcome measures were hypertensive disorders, bleeding in pregnancy, induction of labour, caesarean section, postpartum hemorrhage, preterm birth, small for gestational age, and epidural analgesia. Time trends were analyzed by logistic regression and comparisons made with interaction analyses.

Results

426 347 first births were analyzed, and 3077 (0.7%) women had epilepsy. In WWE there was an increase in proportions of induced labour (p<0.005) and use of epidural analgesia (p<0.005), and a reduction in mild preeclampsia (p = 0.006). However, the risk of these outcomes did not change over time. Only the risk of severe preeclampsia increased significantly over time relative to women without epilepsy (p = 0.006). In WWE, folic acid supplementation increased significantly over time (p<0.005), and there was a decrease in smoking during pregnancy (p<0.005), but these changes were less pronounced than for women without epilepsy (p<0.005).

Conclusions

During 1999–2016 there were important changes in maternal characteristics and complication rates among WWE. However, outcome risks for WWE relative to women without epilepsy did not change despite changes in antiepileptic drug use patterns. The relative risk of severe preeclampsia increased in women with epilepsy.

Klíčová slova:

Birth – Epidural block – Epilepsy – Hypertensive disorders in pregnancy – Labor and delivery – Preeclampsia – Pregnancy – Preterm birth


Zdroje

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2019 Číslo 11