Community-based, prospective, controlled study of obstetric and neonatal outcome of 179 pregnancies in women with epilepsy.
OBJECTIVE
This study evaluated obstetric and neonatal outcome in a community-based cohort of women with active epilepsy (WWAE) compared with the general pregnant population receiving modern obstetric care.


METHODS
We reviewed the total population who gave birth between January 1989 and October 2000 at Kuopio University Hospital. Obstetric, demographic, and epilepsy data were collected prospectively from 179 singleton pregnancies of women with epilepsy and from 24,778 singleton pregnancies of unaffected controls. The obstetric data from the pregnancy register was supplemented with detailed neurologic data retrieved from the medical records. The data retrieved were comprehensive because of a follow-up strategy according to a predecided protocol.


RESULTS
During pregnancy, the seizure frequency was unchanged, or the change was for the better in the majority (83%) of the patients. We found no significant differences between WWAE and controls in the incidence of preeclampsia, preterm labor, or in the rates of caesarean sections, perinatal mortality, or low birth weight. However, the rate of small-for-gestational-age infants was significantly higher, and the head circumference was significantly smaller in WWAE. Apgar score at 1 min was lower in children of WWAE, and the need for care in the neonatal ward and neonatal intensive care were increased as compared with controls. The frequency of major malformations was 4.8% (-0.6-10.2%; 95% confidence interval) in the 127 children of WWAE.


CONCLUSIONS
Pregnancy course is uncomplicated and neonatal outcome is good in the majority of cases when a predecided protocol is used for the follow-up of WWAE in antenatal and neurologic care. Long-term follow-up of the neurologic and cognitive development of the children of WWAE is still needed.
Viinikainen
Katriina
K
Department of Neurology, Kuopio University Hospital and University of Kuopio, Kuopio, Finland.
Heinonen
Seppo
S
Eriksson
Kai
K
Kälviäinen
Reetta
R
D000014:Abnormalities, Drug-Induced / Q000175:diagnosis / Q000453:epidemiology; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D001034:Apgar Score; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000453:epidemiology; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D015931:Intensive Care, Neonatal; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology; D011446:Prospective Studies
D000927:Anticonvulsants