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The offspring of epileptic mother
S K Tamer1, S Misra, S Jaiswal
1Division of Neurology, JLN Hospital & Research Centre, Bhilai, Madhya Pradesh.
Insights
Pregnancy with epilepsy poses risks to offspring, increasing the likelihood of adverse outcomes. This review highlights the impact of maternal epilepsy on fetal development, labor, and neonatal health, emphasizing congenital malformations and treatment challenges.
Area of Science:
- Obstetrics and Gynecology
- Pediatrics
- Neurology
Background:
- Maternal epilepsy during pregnancy presents complex challenges with significant implications for offspring.
- The interaction between epilepsy and pregnancy affects fetal development, labor, neonatal outcomes, and psychosocial concerns.
Purpose of the Study:
- To review the adverse effects of maternal epilepsy on offspring.
- To highlight the increased risks of morbidity and mortality in offspring of epileptic mothers (OEM).
- To discuss management strategies for these complex cases.
Main Methods:
- This article extensively reviews significant observations regarding maternal epilepsy and its impact on offspring.
- It synthesizes data on fetal, neonatal, and congenital outcomes.
- Management strategies are discussed based on available observations.
Main Results:
- Offspring of epileptic mothers (OEM) face increased risks, including low Apgar scores, higher stillbirth rates (1.3-14%), and doubled neonatal/perinatal mortality.
- OEMs exhibit higher rates of prematurity (4-11%) and being small for dates (7-10%).
- Adverse impacts on labor include preeclampsia, abruptio placentae, polyhydramnios, and increased rates of assisted delivery and cesarean sections. Congenital malformations, such as orofacial clefts and cardiac anomalies, are linked to epilepsy and antiepileptic drugs (AEDs).
Conclusions:
- Maternal epilepsy significantly impacts offspring development, leading to increased morbidity and mortality.
- Antiepileptic drug (AED) exposure contributes to congenital malformations and distinct clinical syndromes.
- Management requires alertness from obstetricians and pediatricians to address complications and withdrawal symptoms.
Abstract:
The offspring of an epileptic mother is an issue-currently getting attention because of its several implications. A complex interaction between epilepsy during pregnancy and its adverse impact on foetus, labor, neonate, congenital malformation, psychosocial and medico-social concern and treatment challenges of such cases is increasingly being realised. Some of the significant observations has been reviewed extensively in this article. Maternal epilepsy is likely to adversely affect the off-spring at its various stages of development amounting to increased morbidity and mortality. Increased seizure frequency during pregnancy with resultant increased risk is well documented but its mechanism is poorly understood. Low apgar score, increased still birth rates (1.3 to 14%) in offspring of epileptic mother (OEM) is reported. So also, the neonatal and perinatal deaths are twice more common in OEMS than normal control. Small for dates, and prematurity in OEM is reported to be 7 to 10% and 4-11% respectively. Adverse impact on labor and delivery like preclampsia, abruptio placentae, polyhydramnios, assisted delivery, cesarean section and IUGR poses particular challenges to the obstetrician. Pediatrician's alertness is needed to anticipate and deal with the bleeding manifestation due to deficiency of Vit-K dependent clotting factors and various anticonvulsant drug (AED) withdrawal symptoms. Significant risk of developing congenital malformation is the result of epilepsy perse and the AED used during pregnancy. AED exposure leads to other distinct clinical syndromes, the orofacial clefts and cardiac anomalies being the commonest manifestation. Epilepsy in mother but not in father has significant adverse impact. Management strategies in the context of available observation has been discussed.