title: Impact of planning of pregnancy in women with epilepsy on seizure control during pregnancy and on maternal and neonatal outcomes.
abstract: OBJECTIVE
  To investigate whether planning of pregnancy in women with epilepsy affects seizure control during pregnancy and to compare the maternal and neonatal outcomes in planned and unplanned pregnancies.
  
  
  METHODS
  This was a retrospective cohort study of 153 pregnant women with epilepsy who were treated at the University of Tsukuba Hospital and Hokkaido University Hospital between 2003 and 2011. Twenty-one pregnancies were excluded due to insufficient data. Data of patients followed by neurologists during their planned pregnancies (planned-pregnancy group, n=51) were compared to those of patients referred to neurologists after conception for managing epilepsy during pregnancy (unplanned-pregnancy group, n=81). The treatment profile for epilepsy, seizure control, and maternal and neonatal outcomes in both groups were compared using Chi-square test or Fisher's exact test and Mann-Whitney U test.
  
  
  RESULTS
  Compared to the unplanned-pregnancy group, the planned-pregnancy group showed a significantly greater proportion of patients receiving monotherapy with antiepileptic drugs (80% vs. 61%: planned vs. unplanned, P=0.049) and those not requiring valproic acid (77% vs. 56%, P=0.031). Furthermore, the frequency of epileptic seizures (16% vs. 35%, P=0.018) and changes in antiepileptic drugs (24% vs. 41%, P=0.042) were significantly lower in the planned-pregnancy group than in the unplanned-pregnancy group. No significant intergroup differences were noted in the obstetric complications and neonatal outcomes, including congenital malformations.
  
  
  CONCLUSIONS
  For women with epilepsy, planning of pregnancy is associated with good seizure control during pregnancy and less fetal exposure to antiepileptic drugs.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: abekana@dia-net.ne.jp.
authors.forename: Kanako
authors.initials: K
authors.lastname: Abe
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: hhamada@md.tsukuba.ac.jp.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Hamada
authors.affiliation: Department of Obstetrics, Reproductive and Developmental Medicine, Division of Pathophysiological Science, Graduate School of Medicine, Hokkaido University, Sapporo, Japan. Electronic address: taka0197@med.hokudai.ac.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: manobata@md.tsukuba.ac.jp.
authors.forename: Mana
authors.initials: M
authors.lastname: Obata-Yasuoka
authors.affiliation: Department of Obstetrics, Reproductive and Developmental Medicine, Division of Pathophysiological Science, Graduate School of Medicine, Hokkaido University, Sapporo, Japan. Electronic address: minasho@med.hokudai.ac.jp.
authors.forename: Hisanori
authors.initials: H
authors.lastname: Minakami
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: hyoshi@md.tsukuba.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D004827:Epilepsy / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000628:therapy*; D011256:Pregnancy Outcome; D049168:Pregnancy, Unplanned; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy / Q000628:therapy*; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid
keywords: AED; Antiepileptic drugs; CBZ; Epilepsy; MCM; Monotherapy; Neonatal/maternal outcome; PB; PHT; Planned pregnancy; Seizure control; VPA; VSD; WWE; antiepileptic drug; carbamazepine; major congenital malformation; phenobarbital; phenytoin; valproic acid; ventricular septal defect; women with epilepsy