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Birth outcomes after prenatal exposure to antiepileptic drugs--a population-based study
Demet Kilic1, Henrik Pedersen, Maiken Ina Siegismund Kjaersgaard
1Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Antiepileptic drug (AED) exposure during pregnancy is linked to low birth weight and being small for gestational age (SGA). Preterm birth risk from AEDs was observed only in women without epilepsy.
Area of Science:
- Obstetrics and Gynecology
- Pharmacology
- Neonatology
Background:
- Antiepileptic drugs (AEDs) are commonly used to manage epilepsy during pregnancy.
- Understanding the impact of AEDs on fetal development is crucial for informed clinical practice.
Purpose of the Study:
- To investigate the association between prenatal exposure to antiepileptic drugs (AEDs) and adverse birth outcomes.
- To assess the impact on fetal growth and gestational age at birth.
Main Methods:
- Utilized the Danish Medical Birth Registry and Danish National Prescription Register (1997-2008).
- Included 679,762 singleton pregnancies, with 2,928 exposed to AEDs.
- Employed binomial regression, adjusting for confounding factors, to analyze preterm birth, low birth weight, and small for gestational age (SGA).
Main Results:
- AED exposure was associated with an increased risk of preterm birth, low birth weight, and SGA.
- The association with preterm birth was significant only in offspring of women without epilepsy.
- AED exposure increased the risk of low birth weight and SGA in offspring of both women with and without epilepsy.
Conclusions:
- Prenatal AED exposure is linked to higher risks of low birth weight and SGA.
- Preterm birth risk associated with AEDs was primarily observed in pregnancies of women without epilepsy.
- These findings highlight the need for careful consideration of AED use in pregnancy.
Objective:
We studied the potential impact of antiepileptic drugs (AEDs) on fetal growth and gestational age at birth.
Methods:
In the Danish Medical Birth Registry, we identified all pregnancies with birth outcomes from 1997 to 2008 and linked with data from the Danish National Prescription Register. We used binomial regression to study preterm birth (<37 weeks), low birth weight (<2,500 g), and small for gestational age (SGA), adjusted for potential confounding factors including maternal age, smoking, substance abuse, cohabitation, income, education, and parity.
Results:
We identified 679,762 singletons, and 2,928 (0.4%) of these had been exposed to AEDs. Exposure to AEDs was associated with a risk of preterm birth (adjusted risk ratio (aRR) 1.32; 95% confidence interval [CI] 1.16-1.50) when compared to unexposed children. However, when stratifying on maternal epilepsy, there was no association between AED exposure and preterm birth in offspring of women with epilepsy (aRR 1.00; 95% CI 0.82-1.21), whereas there was a risk associated with AED exposure in offspring of women without epilepsy (aRR 1.56; 95% CI 1.27-1.92). AED exposure was associated with a risk of being born with low birth weight (aRR 1.40; 95% CI 1.22-1.60) both for children born of women with epilepsy (aRR 1.32; 95% CI 1.06-1.63) and children born of women without epilepsy (aRR 1.61; 95% CI 1.28-2.02). The risk of being born SGA associated with AED exposure (aRR 1.21; 95% CI 1.10-1.34) was found both in offspring of women with epilepsy (aRR 1.19; 95% CI 1.02-1.37) and without epilepsy (aRR 1.21; 95% CI 1.01-1.45).
Significance:
Prenatal AED exposure was associated with low birth weight and risk of being born SGA, but only with preterm birth among women without epilepsy.
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