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Antiseizure medications use during pregnancy and congenital malformations: A retrospective study in Saudi Arabia
Bshra A Alsfouk1, Manal Rashed Almarzouqi2, Aisha A Alsfouk1
1Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
Insights
Antiseizure medications (ASMs) may increase congenital malformation risk in infants. However, untreated epilepsy poses higher risks for perinatal complications, suggesting ASMs may be beneficial for managing epilepsy during pregnancy.
Area of Science:
- Obstetrics and Gynecology
- Neurology
- Pediatrics
Background:
- Epilepsy affects women of childbearing age.
- Antiseizure medications (ASMs) are crucial for managing epilepsy but raise concerns about teratogenicity.
- Understanding the risks and benefits of ASMs during pregnancy is vital.
Purpose of the Study:
- To evaluate congenital malformation incidence in infants exposed prenatally to ASMs.
- To assess other perinatal and fetal complications.
- To identify predictors for these complications.
Main Methods:
- Retrospective review of pregnancy outcomes in women with epilepsy.
- Data collected from King Faisal Specialist Hospital and Research Centre, Saudi Arabia (1993-2020).
- Comparison between ASM-exposed, non-exposed, and untreated epilepsy groups.
Main Results:
- Congenital malformations observed in 6.17% of pregnancies.
- Perinatal and fetal complications occurred in 53% of all pregnancies, higher in untreated epilepsy (66.67%) versus ASM-exposed (50%).
- Low birth weight, preterm birth, NICU transfer, and abortion were frequent complications. Use of non-ASM medications increased complication risk.
Conclusions:
- Prenatal ASM exposure is linked to increased congenital malformation risk.
- Overall perinatal complications were higher in untreated epilepsy, potentially due to maternal seizures.
- Benefits of ASMs in controlling epilepsy and preventing complications may outweigh teratogenic risks.
Aim:
To evaluate the incidence of congenital malformations in children exposed prenatally to antiseizure medications (ASMs), to assess other perinatal and fetal complications, and to determine the potential predictors for these complications.
Method:
A retrospective review of pregnancy outcomes of women with epilepsy. Patients were followed up at the King Faisal Specialist Hospital and Research Centre, Riyadh and Jeddah, Saudi Arabia, between Dec 1993 and Oct 2020.
Results:
Of 162 pregnancies included, 10 (6.17%) congenital malformations were observed, 6.82% in ASM-exposed babies versus 3.33% in babies of epilepsy-untreated mothers (P = 0.69). The overall incidence of perinatal and fetal complications was 53%; most frequent were low birth weight (24%), preterm birth (19%), transfer to neonatal intensive care unit (18%) and abortion (8%). These complications were higher in the untreated group (66.67%) than in the ASM group (50%). The use of other non-antiseizure medications during pregnancy was the only factor that significantly increased the risk of complications.
Conclusion:
Prenatal exposure to ASMs was associated with increased risk of congenital malformations. However, overall perinatal and fetal complications were higher in the untreated group than in the ASM group, which could be explained by maternal seizures. Therefore, taking ASMs to control epilepsy and prevent perinatal complications may outweigh the risks of teratogenicity.
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