title: Apgar-score in children prenatally exposed to antiepileptic drugs: a population-based cohort study.
abstract: OBJECTIVE
  It is unknown if prenatal exposure to antiepileptic drugs (AEDs) increases the risk of low Apgar score in offspring.
  
  
  METHODS
  Population-based study using health registers in Denmark.
  
  
  METHODS
  We identified all 677 021 singletons born in Denmark from 1997 to 2008 and linked the Apgar score from the Medical Birth Register with information on the women's prescriptions for AEDs during pregnancy from the Danish Register of Medicinal Product Statistics. We used the Danish National Hospital Registry to identify mothers diagnosed with epilepsy before birth of the child. Results were adjusted for smoking and maternal age.
  
  
  RESULTS
  Among 2906 children exposed to AEDs, 55 (1.9%) were born with an Apgar score ≤7 as compared with 8797 (1.3%) children among 674 115 pregnancies unexposed to AEDs (adjusted relative risk (aRR)=1.41 (95% CI 1.07 to 1.85). When analyses were restricted to the 2215 children born of mothers with epilepsy, the aRR of having a low Apgar score associated with AED exposure was 1.34 (95% CI 0.90 to 2.01) When assessing individual AEDs, we found increased, unadjusted RR for exposure to carbamazepine (RR=1.86 (95% CI 1.01 to 3.42)), valproic acid (RR=1.85 (95% CI 1.04 to 3.30)) and topiramate (RR=2.97 (95% CI 1.26 to 7.01)) when compared to unexposed children.
  
  
  CONCLUSIONS
  Prenatal exposure to AEDs was associated with increased risk of being born with a low Apgar score, but the absolute risk of a low Apgar score was <2%. Risk associated with individual AEDs indicate that the increased risk is not a class effect, but that there may be particularly high risks of a low Apgar score associated with certain AEDs.
authors.affiliation: Department of Neurology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Christensen
authors.affiliation: Research Unit for General Practice, Department of Public Health, Aarhus, Denmark.
authors.forename: Henrik Søndergaard
authors.initials: HS
authors.lastname: Pedersen
authors.affiliation: Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Maiken Ina Siegismund
authors.initials: MI
authors.lastname: Kjaersgaard
authors.affiliation: Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Erik Thorlund
authors.initials: ET
authors.lastname: Parner
authors.affiliation: Research Unit for General Practice, Department of Public Health, Aarhus, Denmark.
authors.forename: Mogens
authors.initials: M
authors.lastname: Vestergaard
authors.affiliation: Regional Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Aarhus, Denmark.
authors.forename: Merete Juul
authors.initials: MJ
authors.lastname: Sørensen
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Jørn
authors.initials: J
authors.lastname: Olsen
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Bodil Hammer
authors.initials: BH
authors.lastname: Bech
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lars Henning
authors.initials: LH
authors.lastname: Pedersen
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects*; D001034:Apgar Score; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011247:Pregnancy; D037841:Pregnant People; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors
chemical_list: D000927:Anticonvulsants
keywords: EPIDEMIOLOGY; PERINATOLOGY